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PubMed2005

Improving nursing unit teamwork.

A lack of teamwork among nursing staff affects care delivery and unit operations. Barriers present in the structure of a typical patient care unit that make it extremely difficult to achieve a high level of teamwork include large team size, lack of familiarity, instability of the work force and assignments, the absence of a common purpose and destiny, and an inhibiting physical environment. The authors discuss strategies to overcome these obstacles to teamwork.

Efficiency, Organizational↗
PubMed2003

The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution.

BACKGROUND: Feeding problems are common in infants and young children. A multidisciplinary team approach contributes to better patient care. However, few quantitative data on multidisciplinary feeding assessment of children have been published. OBJECTIVES The first aim of this study was to characterize the etiology of feeding difficulties in 700 children referred for assessment of severe feeding difficulty. The authors differentiated medical, oral, and behavioral categories. The second aim was to assess the prevalence of prematurity and dysmaturity in the patients and their relationship to the type of feeding problem. METHODS: Clinical data from 700 children aged less than 10 years who were examined for severe feeding problems were analyzed. RESULTS: Close to 50% of the children had a combined medical and oral condition underlying their feeding difficulties. More than half of the children were examined for gastrointestinal conditions, particularly gastroesophageal reflux disease. Behavioral problems were more frequently seen in children aged more than 2 years. The results indicate that oral sensory-based feeding problems are related to past medical intervention. Children with feeding disorders had a significantly lower birthweight for gestational age. Preterm babies were overrepresented in this population. CONCLUSIONS: A multidisciplinary team approach is essential for assessment and management because combined medical and oral problems are the most frequent cause of pediatric feeding problems. A significant relationship was found between the type of feeding problem and age. Infants born preterm and/or with a birthweight below the tenth percentile for gestational age are at greater risk for developing feeding disorders.

Age Distribution↗
PubMedDate not supplied

The perinatal: special care unit: expert care for high-risk patients.

Labor and delivery units are often used to provide care for nonlaboring patients requiring intensive medical and nursing care. The utilization of labor beds in this manner, however, can result in a shortage of beds for those patients who are truly in labor. Unfortunately, patient dissatisfaction, use of supplemental staffing, and ill-prepared, overworked nurses can then become the result of this practice. Clearly, an improved, innovative model of providing care for high-risk perinatal patients is needed. The purpose of this article is to describe how one hospital and its interdisciplinary team met the challenge of providing expert care for complex perinatal patients by creating a unique model of patient care delivery, the perinatal special care unit (PSCU). An advanced practice nursing role, the perinatal nurse practitioner (PNNP) was implemented to provide collaborative care for these patients. This article includes a discussion of positive and negative outcomes that occurred after the PSCU became a reality. Overall, housing patients on the PSCU has eliminated inappropriate use of labor and delivery beds and has led to a more satisfying childbearing experience for all involved.

Academic Medical Centers↗
PubMed2005

A multidisciplinary approach to the toxicologic problems associated with the use of herbal medicines.

In Hong Kong, a multidisciplinary team consisting of a pharmacist, a chemical pathologist, a scientific officer, and a physician has jointly provided an advisory service on herbal safety to healthcare professionals of all public hospitals since August 2000. This paper reports the first 2 years of experience of this team to emphasize the importance of a multidisciplinary approach to herbal poisoning. Twenty referrals received from the public hospitals from August 2000 to June 2002 were reviewed. The diagnosis of herbal toxicity was made after consideration of the temporal relationship between exposure to the herb and the occurrence of the adverse event and the exclusion of other causes. The causal relationship was seen as much stronger if the herb's pharmacological effects could fully explain the adverse event, if there were similar previous reports, and if the toxicological analysis findings were supportive. In 10 patients, the adverse events were deemed unlikely to be related to the use of herbal medicines. In 3 patients, it was concluded that the adverse events were possibly related to the use of herbal medicines. In 7 patients, the causal relationship was seen to be much stronger because the adverse events in these patients simply reflected the pharmacological effects of the herbs consumed and specific toxic ingredients were isolated from herbal residues and patients' urine or serum. The clinical problems arising from the use of herbal medicines included the Aristolochia species causing acute renal failure (n = 1), aconite roots causing aconitine poisoning (n = 2), the Datura species causing anticholinergic poisoning (n = 1), and "yulan" (Stephania sinica) causing tetrahydropalmatine poisoning (n = 3). The 4 patients with acute renal failure and tetrahydropalmatine poisoning received these toxic herbs, which were not listed in the prescriptions, as a result of poor dispensing practice or for other reasons. Toxicological problems associated with the use of herbal medicines are complex and may be easily overlooked. A multidisciplinary team of experts should be made available to provide advice to frontline healthcare professionals.

Acetaminophen↗
PubMed1987

Nursing ethics in an age of controversy.

Nursing ethics is examined within the context of the health care controversy concerning care v cure. Yarling and McElmurry's contention that nursing ethics should focus on autonomy and reform is critically appraised. In opposition, the moral sense of nursing practice is affirmed as the primary focus of nursing ethics. Reform concerns enhancing excellence in nursing within an expanding legitimate authority. The "in-between" situation of nurses is regarded as an excellent position from which to foster communal decisions by teams of health care workers engaged in the moral practice of fostering the well-being of the ill.

Clinical Competence↗
PubMed1991

Principle-oriented ethics and the ethic of care: a creative tension.

Research to date in the field of nursing ethics has overlooked the nature of the guiding moral framework in nursing practice, while focusing primarily on the moral reasoning and moral behaviors among nurses. This research depicts two moral frameworks--a principle-oriented ethic and the ethic of care--as they are experienced by practicing critical care nurses. The interdependence of these two frameworks as they inform the moral experience of the nurse is demonstrated in the analysis of a complex nurse narrative that depicts the nurse's moral struggle.

Beneficence↗
PubMedDate not supplied

A world of no boundaries.

Ken Wilber's philosophy of no boundaries provides a backdrop for letting go of boundaries between art and science, research and practice, and nursing theories. Major nursing concepts are cited from a variety of theoretical persuasions to illustrate a statement of a unified perspective of the discipline. The author calls for exploration of a world of no boundaries in the expansion of nursing knowledge and practice.

Humans↗
PubMedDate not supplied

The management of a multigenerational nursing team with differing qualifications: a qualitative study.

Retiring age is no longer fixed at 39 years of working service by Italian law, so nurses with more than 40 years of service continue to work in the wards, creating a distinct older generation. Moreover, with the closure of nursing colleges and the introduction of university degree courses for nurses, nursing education has changed significantly. This article reports on a study which explored the experiences of chief nurses in the daily management of nursing teams composed of multigenerational nurses who differed in age and qualifications. Husserls' phenomenologic approach was used, interviewing at length a purposeful sample of 10 chief nurses. Five main areas of concern emerged: (a) The generation gaps between peers and team leaders; (b) nomadism versus being settled; (c) conflicting methods of working which result in nothing being accomplished: managing the "flat paradox"; (d) different nursing values, ideals, and visions; and (e) existing generation gaps with the younger staff. The number of younger nurses will increase with time and, as a consequence, the relevance of intergenerational differences must be seriously debated, not only difficulties with age differences but also those relating to nursing education.

Adult↗
PubMed2004

The effectiveness of standard care, early intervention, and occupational management in Workers' Compensation claims: part 2.

STUDY DESIGN: A prospective cohort. OBJECTIVES: To compare the effectiveness of standard care, early intervention treatment, and occupational management in the management of Workers' Compensation injury claims. SUMMARY OF BACKGROUND DATA: The current management of occupational back pain and work-related upper extremity disorders with either standard care or early intervention treatment appears to be ineffective. METHODS: A prospective cohort looked at the effect of one company with access to standard care (primary care) changing to occupational management (worksite encouragement to resume activity and work as soon as safely possible) and then to early intervention treatment (offsite work hardening). This information was then compared with the control company with access to early intervention treatment, which later changed to a combined occupational management/early intervention treatment approach. Survival analysis was used to attempt to explain differences in time to injury claim closure. RESULTS: Occupational management resulted in lower injury claim incidence, duration, and costs than early intervention treatment. Only the covariate of enhanced physical therapist (work hardening) involvement (2001 hazard rate ratio 17.41, 95% confidence interval 3.72-41.51 and 2002 hazard rate ratio 6.22, 95% confidence interval 2.51-15.40) was associated with delayed time to injury claim closure when the company had access to early intervention treatment. Only the covariate of serious injury was associated with delayed time to injury claim closure in the company when it had access to occupational management (hazard rate ratio 1.67, 95% confidence interval 1.05-27.20). CONCLUSIONS: It is recommended that an occupational management approach, in comparison to early intervention treatment and standard care, be considered for management of occupational injuries.

Absenteeism↗
PubMed2006

A multidisciplinary approach to squamous cell carcinomas of the head and neck: what is new?

PURPOSE OF REVIEW: The aim of this article is to review progress in the treatment of head and neck squamous cell carcinomas (in the light of the most recent literature). Due to the complexity of the disease the multidisciplinary approach needs also a multidisciplinary knowledge which this review tries to summarize. RECENT FINDINGS: The multidisciplinary treatment approach to the disease includes predictive and prognostic value of biomolecular and clinical factors, the role of induction chemotherapy and concurrent chemo-radiotherapy, new advances in postoperative treatment, treatment-related side-effects and their impact on patients' quality of life, new targeted therapies and treatment choice for incurable patients. Advances in other disciplines, such as radiation therapy and new imaging techniques, will be considered elsewhere in this journal. SUMMARY: Major advances derived from the strategic use of different treatment and diagnostic modalities. The importance of a multidisciplinary team and knowledge in the approach of this disease should be stressed. Today, a multidisciplinary diagnostic and treatment philosophy is the tool to guarantee the best treatment plan definition, to prevent and relieve treatment adverse effects with the ultimate goal to improve survival.

Carcinoma, Squamous Cell↗
PubMed2006

Emergency physician intershift handovers: an analysis of our transitional care.

The emergency department intershift transfer of patient care is a universal event. Despite the frequency of its occurrence and complexity of issues surrounding the exchange, emergency department patient handover is insufficiently explored in our literature. This article reviews the effectiveness and efficiencies of the handover practice. The authors provide personal opinion regarding favorable parameters for the prehandover, intershift meeting, and posthandover activities.

Continuity of Patient Care↗
PubMed2005

Building research capacity: the role of partnerships.

What "connections"--a broader term than "partnerships"--need to be made to build research capacity? Connections build capacity to the degree that they augment the skills, knowledge and resources of the focal investigator or investigating entity. We suggest that the goal of capacity building through partnerships/connections is to maximize research utility, i.e., its potential to effect desired changes in targeted systems. Specifically, an investigator or research organization must create connections that will enable: the selection and framing of research questions to address matters of importance to relevant stakeholders, especially and necessarily responding to the needs of people with disabilities; the development of a research design adhering to the highest standards of science; and the translation of new knowledge into messages about the results useful to those who are potential beneficiaries, tailoring the message so that it will be clearly "heard" by each respective target audience (including clinicians, other researchers, administrators and/or people with disabilities and their family members). Utility of research traditionally has not comprised the standard for judging research. However, the current focus in Federal funding appears to be shifting, with a demand to assess outcomes (i.e., utility) of research, thus, bolstering the argument to strengthen research utility through creating appropriate partnerships.

Cooperative Behavior↗
PubMed2002

Reconstructive breast surgery: referring physician knowledge and learning needs.

Despite the positive impact that reconstructive breast surgery can have on a woman's quality of life, the percentage of eligible candidates that have this procedure remains surprisingly low. The authors hypothesized that this may be attributable to inadequate knowledge, inadequate information, and/or misinformation available to physicians caring for these patients. A needs assessment of primary care physicians, general surgeons, oncologists, and plastic surgeons was conducted to determine referring physicians' current level of knowledge of reconstructive breast surgery and to discover potential learning needs. This comprised a survey, focus groups, and individual interviews. Referring physicians rated their own knowledge of reconstructive breast surgery as low. Plastic surgeons rated their referring physicians' knowledge as even lower. Specific learning needs were identified, as large discrepancies between referring physicians' self-reported knowledge of individual breast reconstruction topics and their own opinion of their relevance were revealed. In addition, despite evidence to the contrary, more than one-third of referring physicians indicated a belief that a breast reconstruction delayed the detection of local cancer recurrence and adversely interfered with adjuvant oncologic therapy. This lack of knowledge and misinformation may be negatively affecting patient referrals to plastic surgeons, as more than one-third of referring physicians and 90 percent of plastic surgeons believed that eligible candidates were not being offered referrals because of inadequate referring physician knowledge of this topic. Furthermore, patients older than 49 years were not being referred despite the fact that plastic surgeons would consider these patients as potential surgical candidates. Referring physician gender affected both referral patterns and perceived importance of reconstructive breast surgery. Finally, personal beliefs and past experiences played a role both in physicians' decisions to refer patients and in patients' decisions to have breast reconstructions. These deficiencies in information, knowledge, and learning needs should be addressed by educational interventions during residency training and through continuing education endeavors.

Attitude of Health Personnel↗