Certified psychiatric clinical nurse specialists.
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Humans↗
Biomedical subjects
E Merwin
Publications and source records attributed to E Merwin.
Implementation and outcomes of a community-based self-help smoking cessation program.
In a time of budget constraints, health professionals are turning to minimal-contact smoking cessation programs as the most financially feasible alternative for smoking cessation. The purpose of this study was to evaluate a program by the American Lung Association using the manual Freedom From Smoking for You and Your Family (Strecher & Rimer, 1988) in a community-based smoking cessation self-help intervention. Results showed a quit rate of 15%, and study findings were consistent with other similar studies. Those most likely to succeed were over 40 years old, better educated, and among the most confident of quitting at the onset.
Adult↗
Psychiatric nursing outcome research: the state of the science.
A review of the nursing literature from 1989 to 1994 indicates that few psychiatric nursing studies are published in the major nursing research journals. The psychiatric specialization literature includes a large number of studies that are classified as either outcome studies or could serve as building blocks for future outcome studies. Few studies build on prior research, resulting in a weak scientific basis for evaluating the outcomes of psychiatric nursing care. Strategies for increasing the quantity and quality of psychiatric nursing outcome research are presented.
Forecasting↗
De facto mental health services in the rural south.
Health care reform efforts highlighted the continuing scarcity of mental health services for the rural poor. Most mental health services are provided in the general medical sector, a concept first described by Regier and colleagues in 1978 as the de facto mental health service system, rather than through formal mental health specialist services. The de facto system combines specialty mental health services with general medical services such as primary care and nursing home care, ministers and counselors, self-help groups, families, and friends. The nature of the de facto system in rural areas with large minority populations remains largely unknown due to minimal available data. This article examines the availability, accessibility, and use of mental health services in the rural South and the applicability of the de facto model to rural areas. The critical need for data necessary to inform changes in health care relative to rural mental health service delivery is emphasized.
Adult↗
A community-based smoking-cessation program: self-care behaviors and success.
Given the serious health consequences of smoking, nurses need to be well-informed on how to help various client populations with smoking cessation. Much recent research is focused upon effectiveness of various programs to enhance self-efficacy and self-management skills necessary to succeed in permanent smoking cessation. This study used a model based on Orem's Self-Care Deficit Theory to examine specific variables of importance in smoking cessation using descriptors relevant to understanding self-care actions. The model is used to examine the outcomes of a community-based smoking-cessation program. Results indicate that 15% of the final sample quit smoking and 42% reduced smoking while participating in the program. Additional findings are helpful in describing actions taken by subjects who were and were not successful in quitting. Remedies suggested by the American Lung Association booklet "Freedom from Smoking for You and Your Family" were reported by subjects to be helpful in dealing with the most common problems experienced during smoking cessation. Results are applied to public health nursing, emphasizing that smoking cessation is "a process" in which individuals learn strategies that work for them.
Community Participation↗
Creation of state-level Medicare database for healthcare evaluation applications.
The Health Care Quality Improvement Initiative (HCQII) of the Health Care Financing Administration (HCFA) calls for Professional Review Organizations (PROs) to undertake pattern analysis of large administrative datasets for the purposes of quality of care assessment. The limitations of such administrative databases (primarily the MEDPAR file and derivatives thereof) include impoverished information regarding clinical attributes of Medicare enrollees and the process and outcome of their healthcare. This paper describes preliminary efforts to address this problem by the creation of a database, the PRO Concatenated Database (PCD), from the pooled implicit judgment review data of four Peer Review Organizations (PROs). The data elements comprising the PCD were carefully selected to provide important information regarding quality and appropriateness of care. Preliminary inter-state comparative studies employing the PCD are discussed. A method is also described by which the analytical power of state-level databases may be enhanced by linkage to state-level Modeled MEDPAR data which are issued by HCFA and contain patient-level risk-adjusted mortality data. This approach to the acquisition of data whose clinical content is enriched may prove to be particularly useful to the PRO community during the pattern analysis phase of the HCQII. Such analyses will evolve into more detailed studies involving primary data collection followed by dissemination of the results to local healthcare providers. In this manner, the PCD may facilitate rapid feedback regarding the effectiveness of healthcare delivery to the local community.
Aged↗
The lack of services to the retarded through community mental health programs.
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Attitude of Health Personnel↗
Alternative statistical methods to use with survival data.
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Humans↗
Cost-effective integration of mental health professions.
This article describes the need for cost-effectiveness evaluation of the use of labor within mental health systems. It calls for building on the unique knowledge base of each mental health discipline in the development of new models of care that incorporate clients' social and physical needs and rely less on psychotherapy. The utilization and integration of the core mental health disciplines is described. Recommendations for developing more cost-effectiveness utilization of labor are made.
Cost-Benefit Analysis↗
Relationship of clinical case management to hospitalization and service delivery for seriously mentally ill clients.
This article describes the use of a clinical case management team approach in the care of severely mentally ill individuals and the organization of the service. Patient characteristics and use of community services are evaluated as predictors of the use of inpatient care. Findings suggest that hospitalized clients use more community services than nonhospitalized clients and that the use of certain community services--such as medical, legal, and housing services--affects hospital use. Clients who had assistance in obtaining medical services were less likely to be hospitalized, and those needing legal and housing assistance were more likely to be hospitalized.
Adult↗
Building interdisciplinary mental health services research teams: a case example.
The experience of developing an interdisciplinary research team to study outcomes of psychiatric nurse labor use in free-standing psychiatric hospitals is presented. The creation of roles for research team members, the development of working relationships, and the evolution of additional research projects are discussed. Useful suggestions of strategies for developing research teams are presented within the context of proposal development, successful funding, and implementation of a research study.
Health Services Research↗
The role of the principal clinical coordinator in the Health Care Financing Administration's Health Care Quality Improvement Initiative.
The Health Care Quality Improvement Initiative (HCQII) is the Health Care Financing Administration's latest approach to quality management by peer review organizations (PROs) of the health care delivered to Medicare beneficiaries. The principal clinical coordinator (PCC) of each PRO, a physician with both clinical and methodological expertise, has the overall responsibility for all HCQII-related activities. The PCC works with a clinical coordinating team to analyze patterns of care and provide feedback about these patterns to the medical community for the purpose of improving the quality of care. Each PRO provides its PCC with the necessary infrastructure and expertise to conduct pattern analyses and implement the dissemination process. However, the effectiveness of the HCQII will depend largely on the PCC's ability to maintain the full support and cooperation of the local medical community. The success of the PCC role under the HCQII may enable it to serve as a useful model of physician leadership in the quality oversight organizations that will accompany national health care reform.
Cardiology Service, Hospital↗