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At least 1,243 records · Page 69Linked to original sources
PubMed1976

A psychiatrist in a bureaucracy: the unsettling compromises.

Psychiatrists employed by bureaucracies must make a number of compromises in order to reconcile their employing organization's formally stated aims, their superiors' day-to-day expectations, and their traditional role model of physician and patient-oriented therapist. The author studied nine psychiatrists working for the U.S. Army during a two-year period in the mid-seventies. Their adaptation to expectations and pressures of the bureaucracy can be described in one of three general ways: through alignment with the official views of the Army, compartmentalization of roles to meet both patients' expectations and the Army's expectations, or rejection of a military identity.

Adaptation, Psychological↗
PubMedDate not supplied

Institutional differences in therapeutic decision making in the Coronary Artery Surgery Study (CASS).

This article examines institutional differences in therapeutic decision making in the Coronary Artery Surgery Study (CASS). The initial decision to use medical therapy or coronary artery bypass surgery for coronary artery disease is studied. Data from the CASS registry and a survey of CASS principal investigators were used to examine the effects of institutional characteristics, individual physician characteristics, and decision making responsibility on the recommended therapy, the actual therapy, and the ratio of the observed to expected number of surgeries. The results indicated that the experience and involvement of the surgeon in the decision making process were related to actual and recommended rates of surgery. The percentage of urgent transfers from other hospitals and the percentage of surgical referrals to outside hospitals were related to the ratio of the observed to expected numbers of surgery, an adjusted rate of surgery. A major conclusion of this study is that despite the effects of certain institutional constructs, scientific criteria in the form of clinical and angiographic data are the most important determinants of whether a patient receives coronary artery bypass surgery.

Adult↗
PubMed1993

Summary of institutional actions affecting breastfeeding.

It seems appropriate for the lactation consultant to be the advocate for infants and children. We must act ourselves if we want change to occur. When individuals cause even small changes to be made, the cumulative effect can be profound.

Child Advocacy↗
PubMed1998

Further flexing? Issues of employment contract flexibility in the UK nursing workforce.

This paper, based on research commissioned by the Royal College of Nursing (Buchan, 1995), reports on the changing working patterns and flexibility in the employment of nursing staff in the National Health Service (NHS) in the UK. It reviews relevant literature, examines official data and draws information from 12 case study NHS trusts. Flexibility is invariably portrayed as a good thing, and as a means to a positive end, yet is rarely defined in detail, if at all. The aim of this paper is to consider flexibility not as a slogan or panacea, but in terms of the rationales for, and likely effects of, changing patterns of nursing work. It examines the reasons why NHS employers have been attempting to increase the flexibility of their nursing workforce.

Contract Services↗
PubMed2004

Changing boundaries: modes of coexistence of alternative and biomedicine.

In this article, the authors address the boundaries of institutional structures, the dynamics of their configuration, and the nature of their permeability. The authors explored these issues in Israel, where the changing relationship of bio- and alternative medicine elucidates recent processes of professional boundary redefinition. They used qualitative methods to analyze in-depth interviews in clinics and hospitals where alternative and biomedical practitioners work under the formal auspices of publicly sponsored biomedical organizations. The findings show an incursion by alternative practitioners into territories viewed until fairly recently as the exclusive domain of biomedicine. However, the "alternatives" are not defined as regular staff members, and their marginality is elucidated by a variety of visible structural, symbolic, and geographical cues. The authors used decoupling theory in interpreting the findings. Changed boundary contours signal underlying processes of social change that could have meaningful implications in defining membership criteria in the biomedical community.

Ambulatory Care Facilities↗
PubMedDate not supplied

Monitoring chronic outpatient infections: providing comprehensive home healthcare pharmacy services.

Management of acute illness has been increasingly shifted to community practitioners. Expansion of community pharmacy into home healthcare has brought new opportunities and responsibilities to community practitioners. These practitioners are gaining expertise in total parenteral nutrition, intravenous infusion systems, intravenous catheters, parenteral antibiotics, and clinical pharmacokinetics--areas historically managed by hospital and long-term care facility pharmacists. This shift to community pharmacy-based care has brought with it the need for community pharmacists to develop expertise in therapeutic monitoring of chronic disease states. Dose adjustment of medications based upon careful analysis of blood concentrations is no longer limited to institutional pharmacy practice. Community pharmacists now must master basic infectious disease principles and possess internal medicine knowledge to ensure appropriate monitoring of their patients. This article discusses several disease states currently managed with community pharmacy-based home healthcare, summarizing basic monitoring parameters for comprehensive patient care, and provides sample supply lists and documentation forms for home healthcare providers.

Anti-Bacterial Agents↗