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PubMed2000

Educating the nursing workforce in 2000 and beyond.

Changes in the health care delivery system have comparable impacts on both nursing practice and education, such that tomorrow's nursing practice would best emanate from innovative partnerships between leaders in practice and education. For the foreseeable future, an expert nursing workforce is needed in an expanded form, but an array of challenges to maintaining this workforce are evident. Recent and continuing scientific and technologic advances in health care make the matching of practice and education to evolving trends paramount. Regardless of what the future holds, generative leadership in any realm of practice is essential to move our profession into the forefront of health care.

Delivery of Health Care↗
PubMed1989

Unlicensed persons in patient care settings. Administrative, policy, and ethical issues.

The current nursing shortage is a supply-and-demand problem. Factors contributing to the shortage include increased hospital use of RNs; decreased nursing school enrollment; increased demand for RNs outside of hospitals in skilled nursing facilities, health maintenance organizations, and home health care programs; noncompetitive salaries; and lack of autonomy. The nursing shortage has triggered the development and implementation of programs to prepare non-nurse bedside technicians to work in partnership with RNs. The functions of these unlicensed persons range from housekeeping, stocking, and clerical responsibilities to several technical treatments that once fell within the role responsibilities of registered or practical nurses. The partnerships between unlicensed persons and RNs in patient care settings have given rise to several administrative, policy, and ethical issues for nurse leaders. An ethical analysis, based on the application of ethical principles and moral dilemmas found in "The Parable of the Sadhu," offers some guidelines to nursing leaders in the administrative and policy decisions inherent in the development and retention of licensed persons in patient care settings. Some conclusions drawn from the ethically based questions are: The acquisition and retention of RNs and other licensed caregivers should take precedence over the development of programs for non-nurse bedside technicians. RNs in partnership with unlicensed persons in patient care settings must know what they can legitimately delegate. The RN has personal responsibility for ensuring optimal standards of nursing practice in the delegation of duties. The partnership between professional nurses and unlicensed persons must be a participative effort, not a manipulative or coercive one. In putting the organizational principle of subsidiarity into practice, decision makers will be able to maintain respect for human dignity and the uniqueness of patients and caregivers as well. The development and retention of unlicensed persons in patient care settings depends on a well-developed personal ethic that needs to be congruent with the mission, philosophy, and codes of ethics of national and local health care organizations.

Allied Health Personnel↗
PubMed1977

Patients of record.

Although the case of Smith vs Jones helped settle some of the problems in defining patients of record, it did not address itself to all the situations in which a definition of patients of record would be needed. The question of which dentist should have the records of certain patients will present difficulty as long as two or more dentists continue to practice without a formal agreement that addresses this question. And the rights of partners, associates or employees should be determined in writing in the partnership agreement, employment contract, or bylaws of corporate practice before the association is established.

Dental Records↗
PubMed1997

Evaluating a statewide partnership for reducing risks for chronic diseases.

We describe a case study evaluation of Kansas LEAN, a statewide partnership with the mission of reducing risks for chronic diseases through dietary and exercise modification. We used a case study design to examine five primary questions related to process and outcome: (a) were the goals of the partnership important to constituents? (process), (b) were constituents satisfied with the partnership (process), (c) were community or systems changes (new or modified programs, policies, or practices) facilitated by partnership efforts (outcome)?, (d) were these changes important to the partnership's mission (outcome)?, and (e) what critical events helped facilitate community changes (outcome)? several measurement instruments--a monitoring and feedback system, constituent surveys, and semistructured interviews--were used to address key evaluation questions. Kansas LEAN is a strong statewide partnership with involvement from key representatives throughout Kansas. It is an ongoing, comprehensive health promotion program that plans and implements multiple components, in a variety of settings, to create awareness, behavior change, and a supportive environment. Kansas LEAN has facilitated several important community or systems changes related to its mission. We conclude with a discussion of the challenges of evaluating partnerships that seek to reduce risks for chronic diseases.

Acute Disease↗
PubMed1993

Critical care management in the 1990s. Making collaborative practice work.

The creation of a partnership, the hallmark of true collaborative practice, is an ongoing, dynamic process. It demands commitment, energy, and creativity. It is learned and therefore must be role modeled. One must remember that it takes time to develop collaborative relationships. One must begin slowly, walk not run, and have realistic expectations. It is a joy to work in an environment that has developed and is in the process of continually developing true collaborative practice. Hope for the future of health care lies in our ability to deliver coordinated and collaborative care. Nursing, medicine, and administration together can and must provide the solutions to our health care delivery problems before those solutions are legislated. We must set policies and priorities to appropriately allocate scarce resources. We must address personnel needs, credentialing, and compensation to ensure adequate numbers of qualified staff to meet the growing needs of our patients. We must evaluate technology and our physical environments to determine the types of services that we will offer. We must continue to broaden our collaborative efforts to extend from the patient care arena into the realms of education, research, and administration. It is up to each of us and each of our colleagues to work every day toward a more collaborative practice environment. By empowering each other, we can put into place a collaboration which "works jointly with others in intellectual endeavors" rather than one which merely "cooperates with an enemy force."

Cooperative Behavior↗
PubMed1997

Partnerships in healthy cities and communities: a social commitment for advanced practice nurses.

People, recognizing that health is influenced by factors affecting the broader environment, are building healthier communities locally. The principles of the Ottawa Charter for Health Promotion gave direction for the development of the Healthy Cities movement globally. Community-oriented advanced practice nurses (APNs) have skills and expertise to support community leaders in their efforts to build healthier communities. Examples of partnerships involving Healthy Cities and Communities and APNs include: community leadership development, community assessment, nurse managed services, research, and policy advocacy. Based on APN experiences in community health promotion, future challenges are suggested.

Community Health Nursing↗
PubMedDate not supplied

The emerging medical/industrial complex. The industrialization of medicine.

Until recently, the traditional practice of medicine has been thought of as a cottage industry practiced by individuals or small partnership groups. The transition of practice settings to large groups, multi-specialty groups, and corporations has paved the way to industrialization, with even larger health care organizations primarily managed by non-physicians. The similarities of these events to the industrial revolution and its impact on crafts guilds are striking. In order to understand this point of view, this article explores the function and influence of crafts guilds during stages of industrial development and the dynamics of the changes of employment needs and employability in an industrial environment as a comparison to what is happening in the health care field.

Academic Medical Centers↗
PubMed2006

Measures to improve knowledge and self-care among patients with COPD: A UK general practice audit.

The Parchmore Partnership, London, audited 11 evidence-based criteria relating to patient knowledge and COPD morbidity during December 2004 to March 2005 using questionnaires and practice records. 32 patients with moderate to severe COPD participated, and during the project they received information and extra care. Patient knowledge and clinical indicators showed significant improvements.

Health Knowledge, Attitudes, Practice↗
PubMed1985

Provision of first contact care out of hours in four urban areas in England.

In a typical two week period in 1984 in three urban areas with general practitioner deputising services roughly 40% of first contact patient encounters out of hours were with hospital accident and emergency departments, and only a quarter were with general practitioner deputising services, although 47%, 64%, and 97% of general practitioners in the areas had permission to use such services. Roughly a third only of the encounters were with the practices themselves, and even fewer occurred overnight (11 pm-7 am). In a fourth urban area where 68% of general practitioners formed an out of hours cooperative rota a third of the encounters were with the accident and emergency department and half (more overnight) were with the rota. The presence of a woman principal in a practice and large partnerships of four principals or more were associated with an increased proportion of encounters with the practice itself. Undue prominence may have been given to the role of deputising services in out of hours care. Paradoxically, the use of general practitioner cooperatives may result in even less personal care being given by the patient's own practice.

Data Collection↗
PubMed1986

Sex differences in the practice patterns of recently trained obstetrician-gynecologists.

Sex differences in practice patterns, as modified by family roles, are investigated in a national survey of 1420 active obstetrician-gynecologists who graduated from medical school between 1974 and 1979. Women are more likely than men to be practicing in multispecialty groups, and men are more likely than women to be practicing in obstetrics-gynecology partnerships. On average, men and women report working over 60 hours per week. In all practice arrangements except academic medicine, women work fewer total hours per week, although the differences are small and translate into significantly fewer patient encounters than men in only two practice arrangements: partnerships and multispecialty groups. When marital status and presence of children under age 18 are controlled, significant sex differences in hours worked remain only for married respondents with children. Family roles have an opposite effect on hours of work reported by men and women, decreasing the number of hours worked by women and increasing the number worked by men.

Adult↗
PubMed1995

Client-centred practice: what does it mean and does it make a difference?

During the past 15 years, occupational therapists in Canada, through the Canadian Association of Occupational Therapists, have worked to develop and implement guidelines for practice of a client-centred approach to occupational therapy. One of the difficulties with the current Guidelines for the Client-Centred Practice of Occupational Therapy is the lack of a definition and discussion of the concepts and issues fundamental to client-centred practice. In this paper, key concepts of client-centred practice: individual autonomy and choice, partnership, therapist and client responsibility, enablement, contextual congruence, accessibility and respect for diversity are discussed. Two practice examples are used to illustrate these ideas and raise issues about obstacles to the practice of client-centred occupational therapy. Research evidence about the effectiveness of client-centred concepts in enhancing client satisfaction, functional outcomes and adherence to health service programmes is reviewed.

Canada↗
PubMed2005

A concept analysis of partnership with clients.

The aim of this first paper of two about partnership working with clients is to define and clarify partnership as it is practised within health visiting, by identifying the central notions of partnership working in practice. The aim of the second paper will be to describe an evaluation of a training course in partnership working for health visitors. Partnership is a word in common usage within the health professions but its meaning is ill-defined. A literature search was undertaken to identify ways in which previous authors have used the concept within nursing, counselling and health visiting. Rodgers' approach to concept analysis was undertaken to seek clarity for the concept. This revealed the ways in which various authors have used the word, an analysis of its defining attributes, surrogate terms, antecedents, consequences and a concluding definition. The results showed that partnership with clients in health visiting can be defined as a respectful, negotiated way of working together that enables choice, participation and equity, within an honest, trusting relationship that is based in empathy, support and reciprocity. It is best established within a model of health visiting that recognises partnership as a central tenet. It requires a high level of interpersonal qualities and communication skills in staff who are, themselves, supported through a system of clinical supervision that operates within the same partnership framework.

Clinical Competence↗
PubMed1982

A university of department of family medicine after ten years.

The Department of Family Medicine at the University of Washington was started ten years ago after a major curriculum change in the medical school placed new emphasis on education and training of family physicians for the surrounding region in Washington, Alaska, Montana and Idaho (WAMI). This department has organized active programs in patient care, teaching and research at the university base and in a number of affiliated community sites throughout the region. The department is well accepted within the mission of the medical school. Almost a third of graduating medical students choose postgraduate training in family practice. Almost 90 percent of the graduates of the ten programs within the department's network of family practice residencies are established in active family practices, with more than two thirds settling in the WAMI region. Follow-up studies show that these graduates feel well prepared for their practices; are providing a broad range of services in rural, suburban and urban settings; are typically involved in partnership or group practice; and are generally well satisfied with their personal and professional lives.

Curriculum↗