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Operationalizing Donna Wong's principle of atraumatic care: pain management protocol in the NICU.
Atraumatic care is the philosophy of providing therapeutic care through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and families (Whaley & Wong, 1995). The foundation of this principle lies in minimizing separation of child from family, identifying child/family stressors, minimizing/preventing pain, and promoting parent-professional partnerships. A review of pain management practices in one neonatal intensive care unit demonstrated underprescription and under-administration of pain medication as well as inconsistencies among practitioners. Written guidelines, developed by an interdisciplinary team and provided here, integrated current research in the assessment and management of procedural, postoperative, and other pain in infants. Use of the pain management guidelines, which serve as a foundation for the unit's commitment to atraumatic care, have improved pain management practices and have standardized care for infants on the unit.
Increased collaboration between primary care and psychiatric services. A survey of general practitioners' views and referrals.
AIM: To evaluate a primary care partnership between the Rockingham-Kwinana Mental Health Service and Division of General Practice including a memorandum of understanding to streamline referrals, a consultation-liaison service, and a Balint group. METHOD: A questionnaire was sent to all 74 general practitioners in the Division. Standardised interviews compared GPs using the service with those who did not. We compared content of GP referrals before and after implementation with referrals of a control area (Armadale). RESULTS: Thirty-four GPs (45%) returned questionnaires and 46 (62%) participated in interviews; 26 (80%) found the duty officer useful as a point of first consultation-liaison contact; 19 (60%) used referral forms. Most (80%) were aware of the consultation-liaison service and half had either used it or the Balint group. Referral content changed significantly compared to Armadale. DISCUSSION: This study had weaknesses: it relied on self report and retrospective information on GP work practices, knowledge and interests, and nonblinded assessments of referral letters. Primary care partnerships may improve GPs' self reported skills in managing psychiatric disorder and referral behaviour.
The influence of practice characteristics on the prescribing of benzodiazepines and appetite suppressant drugs.
BACKGROUND: The prescribing volume of benzodiazepines and of appetite suppressant drugs have been suggested as possible indicators of prescribing quality. OBJECTIVE: To investigate the variation among general practices in the prescribing of benzodiazepines and appetite suppressants by examining the contribution to this variation of training status, partnership status, fundholding status and the level of deprivation in the practice population. METHODS: Prescribing data (PACT) were analysed for 350 practices in the former Mersey Regional Health Authority, for the year ending March 1991 and the year ending March 1994. Data were first standardized for variation in practice population demography. Multiple linear regressions were used to investigate the variation among practices in standardized prescribing volume in both years. RESULTS: For benzodiazepines, training status and partnership status contributed to all models and level of deprivation contributed to some (percentage of variation explained for year ending March 1991: 10% to 21%, year ending March 1994: 8% to 20%). For appetite suppressant drugs fundholding status and an interaction between training status and level of deprivation contributed to all models in both years (percentage of variation explained for year ending March 1991: 19% to 20%, year ending March 1994: 20% to 21%). CONCLUSION: The prescribing of benzodiazepines is lower in training practices, in multi-partner practices and in practices serving a less deprived population, while the prescribing of appetite suppressant drugs is lower in training practices and in fundholding practices. Variation in prescribing knowledge, organizational and management capabilities and patient demand may be explanatory factors.
Creating partnership synergy: the critical role of community stakeholders.
While there are compelling reasons for professionals in health and human services administration to collaborate with other stakeholders in the community, the experience with such partnerships thus far has generated more frustration than results. Recent research on partnership synergy--a key indicator of a successful collaboration process--suggests that many of these partnerships are inadvertently compromising their own success by the way they involve community stakeholders. Applying research findings to current practice, this article shows how the ability of a partnership to understand and address complex problems--and sustain interventions over time--is related to who is involved in the partnership, how community stakeholders are involved, and the leadership and management of the partnership. The article addresses key challenges that health and human services administrators face when they seek to optimize the role of community stakeholders in partnership.
The value of international collaborations for supporting neuroanesthesia practice, education, and research in resource-constrained settings.
PURPOSE OF REVIEW: Neuroanesthesia practice in low- and middle-income countries is constrained by workforce shortages, limited infrastructure, and variability in clinical practice. Growing global interest in collaboration makes it timely to evaluate how international partnerships can address these gaps and improve equity in care, education, and research. RECENT FINDINGS: Recent literature highlights substantial variability in neuroanesthesia practice and limited access to context-appropriate guidelines and advanced technologies. International collaborations, including training partnerships, scholarship programs, and research networks, have improved knowledge exchange, workforce development, and the adoption of standardized practices. Evidence suggests that specialized training is associated with improved clinical outcomes. However, persistent inequities in research participation, authorship, and leadership, as well as concerns regarding sustainability and 'parachute research', remain. SUMMARY: International collaboration is a key strategy for advancing neuroanesthesia in resource-constrained settings. Sustainable, equitable partnerships that prioritize local ownership, capacity building, and contextual adaptation are essential to improving clinical practice, strengthening education, and enhancing global research representation.
Supporting student nurses learning in and through clinical practice: the role of the clinical guide.
Practice learning is an important part of the curriculum and accounts for approximately 50% of the pre-qualifying nursing programme in the United Kingdom. However, the nature of practice learning is very often ill defined, and mentors and nurse teachers apply a range of models to enhance learning in practice settings. Supporting students to learn is an important function for both educators and practitioners, yet there is little consensus in the literature as to what constitutes appropriate support and more importantly which methods promote deep learning. Mentorship is widely relied upon not just as a support mechanism for students but also as the main vehicle for the activities associated with learning, teaching and assessment of practice. Although in recent years nurse education in the UK has embraced mentorship alongside the development of the lecturer practitioner and more recently practice educator roles, other models may be worth further examination, especially those that more overtly enable students to learn through clinical practice encounters. The Clinical Guide is a concept developed by the University of Salford as part of a response to the Fitness for Practice report (UKCC 1999), which encourages Higher Education Institutions together with health care providers to develop partnerships to support students and deliver and monitor learning in practice. The following account outlines the role of the Clinical Guide in relation to pre-registration nursing students and highlights some general inadequacies of the mentor's role in developing deep learning in students in practice settings. It does acknowledge the part mentors have to play in the supporting students and relates to the research literature in this area.
School health nursing: framework for the future. Part II.
The relative prestige that school health nursing currently enjoys provides a positive climate in which to advance this nursing specialty. To fully capture this advantage, the profession and its practitioners need to address some practice issues while reinforcing its community-based influence on the health and educational success of America's school-age children. Part I of this series addressed the societal environment in which school nursing finds itself, the factors that support school health nursing programs, and the need to develop new and expanded partnerships. Part II speaks to the professional, practice, and management issues facing school nurses and offers strategies for creating a solid framework in the 21st century.
Managing a pediatric hospitalist practice requires team approach.
Establishing and maintaining a productive hospitalist program relies on the forging of multiple partnerships involving pediatric hospitalists, community practitioners, and administrative organizations including hospitals and multiple practice groups. When these professional relationships are successful, everyone in the relationship benefits, especially the children and families who deserve the best medical practices that can be offered. Establishing these relationships within defined communities ultimately improves pediatric outcomes.
Assessment of family-centered care policies and practices for pediatric patients in nine US emergency departments.
INTRODUCTION: Family-centered care recognizes the integral role of the family in the health and well-being of the pediatric patient. However, implementing a family-centered care approach often requires significant philosophical, practice, and environmental changes. A self-assessment inventory of family-centered practices can identify areas for change. METHODS: ENA conducted a validation study on an instrument used to assess family-centered care in the emergency department. Nine emergency departments of varying demographics used the Family-centered Care Self-assessment Inventory to evaluate their family-centered care practices. The inventory is organized into 7 sections: (1) vision, mission, and philosophy of care; (2) family support; (3) information and decision making; (4) services coordination and continuity; (5) personnel practices; (6) quality improvement; and (7) community partnerships. Individual and group interviews were completed with a variety of staff in each emergency department. RESULTS: All 9 emergency departments demonstrated some integration of family-centered care principles. However, staff knowledge about family-centered care varied. Support of family-centered care was most consistent in the departments with specific competencies, educational programs, and practices that were inclusive of the family. DISCUSSION: The Family-centered Care Self-assessment Inventory tool was effective in evaluating family-centered care for pediatric patients in emergency departments. The assessment tool helped the departments to identify current family-centered care practices. Based on those assessments, the departments were able to identify areas of strength and opportunities for improvement in the care of children and their families.
Four years of lessons learned: The 2001-2004 Maryland influenza prevention seasons.
More than 36,000 Americans die and 200,000 more are hospitalized because of influenza every\year. Despite the wide availability of a vaccine to prevent influenza, the vast majority of Americans go unimmunized. The Maryland Department of Health and Mental Hygiene (DHMH) and the Maryland Partnership for Prevention (MPP) collect data about the state's local health departments' influenza season practices and experiences and compile them into the annual Maryland Influenza Season Final Report. The report becomes a tool for DHMH, MPP, and the state's 24 local health departments to plan improvements in influenza vaccination services. This article chronicles four influenza seasons. Influenza season challenges experienced in three of the last four influenza seasons underscore the importance of coordination and communication efforts to ensure that vaccine is efficiently delivered to the most vulnerable populations. The partnership between DHMH and MPP has facilitated access to information on ordering and administration practices, communication systems, community partnerships, and lessons learned, thus enabling the state of Maryland to continually optimize its influenza vaccination promotion efforts.
Formula for surgical practice resuscitation in an academic medical center.
BACKGROUND: Managing patient referrals for surgical consultation in an academic practice has traditionally emphasized clinical rather than service expertise. However, assuring both efficiency and accuracy in the initial consultation have become critical early measures of quality care. METHODS: In partnership with the academic medical center administration, current practice was analyzed. Performance and communication standards were established around an ideal patient experience. A new ambulatory consultation process was developed; and flowcharting methods for resource allocation, statistical process control, and pre-visit data collection were used to reduce patient administrative time. Automated referral reports engaged referring physicians throughout the consultation. RESULTS: Accurate insurance and referral authorization have been provided for all patients, including the 4% who are underinsured. Patient, provider, and referring physician satisfaction has increased significantly. Staff time investment has progressively declined from 52 +/- 11 (95% confidence) minutes to 34 +/- 10 minutes for most patients. Realignment of tasks has reduced the administrative time spent by the patient by 32% without compromising clinical time. New patient volume increased by 29% per year, maintaining regional market share. CONCLUSIONS: Expertise in the process of consultation delivery is feasible and will be increasingly critical to the survival of academic surgical practice in a competitive market.
Twenty-first-century primary care: new partnerships between nurses and doctors.
What role will advanced practice nurses (APNs) play in tomorrow's health care system? The author shares her answer to this question by first looking at the history of APNs and nurse practitioners (APNs whose focus is primary care), explaining what they do, and tracing their increasing success in overcoming long-standing barriers to full acceptance as providers of care. The author emphasizes that while APNs' advancement has usually been based on demonstrating sameness of practice processes and outcomes with those of physicians, in actuality, APNs-whose advanced primary care is delivered with full accountability and is indistinguishable from such care delivered by physicians-offer a different style of practice, which involves caring, nurturing, support, engagement with patients, attention to illness prevention and health promotion, and patient education. It is this difference on which APNs' survival rests. The author then discusses the educational training, economic, marketplace, and other questions that must be answered if APNs and physicians are to achieve a non-competitive, richer future, one in which both work together as partners rather than as members of a hierarchical team. Ultimately, such a future will be possible only when APNs have the same independence, access to patients, and voice in the treatment plan that physicians do.
Essential ingredients for a successful hospital-physician partnership.
Our hospital and a nearby multispecialty physician group practice over- came a competitive relationship to become successful partners in meeting the needs of the community.
Comprehensive statewide approach to improve youth outcomes: experience of the New York State Youth Development Team.
Best practice research indicates a need for a policy shift toward positive youth development (YD) principles and strategies. The New York State Youth Development Team (YDT) is a public-private partnership of leading agencies whose holistic vision, "families, schools and communities partner to support the development of healthy, capable and caring youth," requires key stakeholders at all levels to address adverse youth health outcomes through effective partnerships. To transform the YDT vision into statewide practice requires committed actions (policy, funding, and training) at the state and community levels. Key lessons learned and experience-based recommendations that guide YD efforts in New York State can help state and local agencies move more to a positive YD approach that helps young people become healthy, caring, competent, and contributing adults, fully prepared to be parents, workers, leaders, entrepreneurs, and citizens of the future.
An addiction agency's collaboration with the drinks industry: Moo Joose as a case study.
AIM: This paper analyses a partnership between an addiction agency and the drinks industry in Australia, with special reference to concerns held by public health advocates for such projects. METHOD: Public health anxieties regarding collaboration between the drugs sector and the drinks industry are identified. A projected partnership between the Alcohol and Drug Foundation--Queensland (ADFQ) and the liquor industry in Australia is reviewed. The partnership involves the creation of a new organization, Alcohol Education Australia Ltd. (AEA), which states as its aim the education of consumers in responsible drinking. In order to assess the impact of the partnership an examination is undertaken of the AEA's stated mission and objectives, of relevant policy development by ADFQ and of ADFQ's intervention in support of an alcohol manufacturer which was putting a case to a licensing authority. FINDINGS: The results indicate the partnership advances the interests of the drinks industry rather than public health. The mission and objectives of Alcohol Education Australia Ltd subordinate public health goals to industry aims and the host organization, the ADFQ, has changed its policy and practice to accommodate the drinks industry. CONCLUSION: The partnership between the ADFQ and the drinks industry indicates the difficulty faced by addiction organizations in maintaining an uncompromising public health orientation when in partnership with the alcohol industry.
Research and the configuration of nursing services.
This paper is concerned with the way in which nursing research has influenced changes in the organization of nursing services, particularly the shift from so-called traditional nursing to new nursing. To this end published research and professional literature are selectively reviewed. The case is made to support the view that change in nursing has been driven forward by the evangelical zeal of opinion leaders rather than evidence. It is suggested that holistic care as embodied in new nursing is no longer affordable. Market pressures have precipitated a revisiting of the task basis of nursing. An effective anchor would have been a solid body of research evidence pointing up the value new nursing may have. Regrettably not enough research was done prior to the diffusion of new nursing. What was done was not always adequate, and what was adequate was not effectively deployed by nurse leaders. Nursing is the largest workforce in the NHS and has attracted a great deal of policy interest. It is suggested that it will become increasingly important for nursing to be more strategic, and develop its own professionally driven research agenda. The future of the nursing profession in uncertain. It is clear that evidence-based practice is centre stage, and there is a need for nursing to re-negotiate its professional boundaries and to develop intellectual partnerships in order to move the knowledge base of practice forward.
Hospitals' marketing challenge: influencing physician behavior.
Physicians' referring and admitting behavior as well as their clinical management practices are major determinants of hospitals' profitability under prospective payment. Four techniques are available to hospitals that seek to increase market share: Recruitment and retention strategies. In planning the mix of specialties represented on staff, hospitals should consider the effects of a physician's practice on the hospital's case mix. Peer pressure. Peer review programs in hospitals as well as through medical or specialty societies may help persuade physicians to alter their use of services. Education and information programs. Hospitals can assist physicians in patient management by conducting economic grand rounds, developing committees to study and communicate cost data to physicians, and providing information on alternatives to hospitalization. Incentives. Putting physicians at risk by linking planned expenditures to hospital financial performance can influence practice patterns. Other techniques include offering limited partnerships to medical staff members and merging the hospital and medical staff into one corporation. Hospitals may also need to influence physicians away from ventures that compete directly with the institution, such as ambulatory surgery centers.