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Biomedical subjects

N Hoffart

Publications and source records attributed to N Hoffart.

At least 19 recordsLinked to original sources
PubMed1998

The future of end-stage renal disease care: nephrology enters a new millennium.

There are many challenges facing the discipline of nephrology as we enter the next millennium. There will be a continuing increase in the number of patients requiring renal replacement therapy, with older, sicker patients predominating. At the same time the available workforce to provide care to these patients is not growing quickly enough to keep up with the demand. In the broader health care delivery system, consolidation of services, vertical and horizontal integration, a continued move to for-profit entities, and constant pressure on cost containment will increasingly characterize the immediate future. The rapidity with which health care delivery and financing are changing will make it difficult for patients and health care professionals alike, but it will also offer opportunities. In nephrology, development of a collaborative model of care has already begun and will be an important part of the response to this changing care environment. Collaborative care and the application of the principles of chronic disease management to renal patients will provide the best opportunities to capitalize on new technologies and treatments as they become available and to streamline and improve the care delivery process. This should lead to improved quality of care for renal patients, while constraining costs and providing for continued professional growth and satisfaction.

Delivery of Health Care↗
PubMed1998

Elders' decision making regarding the use of long-term care services: a precarious balance.

The purpose of this qualitative study was to explore factors that influenced decision making regarding the use and nonuse of long-term care services, with a particular focus on elders' attitudes, values, and beliefs. The sample (N = 27) consisted of high-functional elders recently admitted to nursing homes and community-dwelling, high-risk elders recently diverted from nursing homes following a prescreening program. Data were collected through indepth, face-to-face, semistructured interviews and analyzed using qualitative content analysis. Independence and sense of self were the strongest values to emerge. The attitude of acceptance, both passive and active, helped elders cope with increasing levels of dependency and lifestyle changes. The desire to be part of decisions, both major life planning and day-to-day choices such as meal planning, was pervasive. Decision making was individualistic and complex. Loss of control was threatening to the sense of self, leaving some elders feeling shortchanged.

Activities of Daily Living↗
PubMed1997

Self-scheduling in five med/surg units. A comparison.

As part of an Enhanced Professional Practice Model, self-scheduling was implemented in five medical/ surgical units. Each unit had varying degrees of success. The five factors that influenced successful implementation-committee structure, staff education, negotiation skills, guidelines and managerial support-are discussed.

Decision Making, Organizational↗
PubMed1997

Using qualitative research in the management of health care.

Studying everyday life of health care clients and workers can increase the nurse administrator's understanding of the process and impact of changes occurring in today's health care environment. In this article the authors describe qualitative research and the contributions it can make to health care management. Examples of published qualitative research in four areas (organizational behavior, organizational processes, individual perceptions, and leaders' roles and functions) illustrate these contributions. Ways in which nurse administrators can apply qualitative research methods to their work are addressed, including needs assessment, marketing, and program evaluation.

Delivery of Health Care↗
PubMed1997

Decision making by high functional status elders regarding nursing home placement.

An analysis of the Minimum Data Set Plus (MDS+) from one midwestern state revealed a group of "high functional elders" entering nursing homes, who potentially could be served in the community at a lower cost. The purpose of this qualitative study was to identify and better understand the reasons why these apparently high functioning elder adults entered nursing homes. Data from the 1995 MDS+ were used to identify "high functional" elders recently admitted to the nursing home from two urban and seven rural counties. Data were collected through in-depth, face-to-face, semi-structured interviews and analyzed using qualitative content analysis. Of the 33 persons judged to be high functional, only 36% remained in the nursing home 3 to 6 months later. Most elders were using a wide array of community-based services and extensive informal support networks prior to entering the nursing home. Most described specific events that forced them into the nursing home environment. Health needs, specifically the need for 24-hour care or supervision, emerged as the dominant factor for remaining in the nursing home. Of the 12 elders interviewed, all demonstrated some evidence of cognitive impairment. This study suggests that there are persons in nursing facilities today for whom community-based services, such as affordable assisted-living, would be reasonable and appropriate. Case managers may be the most qualified not only to assess for and coordinate services, but also to advocate for affordable services that preserve elders' functional status.

Activities of Daily Living↗
PubMed1996

The effect of a professional practice model on staff nurse perception of work groups and nurse leaders.

OBJECTIVE: The objective of the study was to measure the effect of an enhanced professional practice model on perception of work groups and nurse leaders. BACKGROUND: Previous studies of staff nurse perception of work environment and nurse leaders were used to guide development of the professional practice model and the selection of variables. Implementation of the model was expected to result in more favorable perceptions of the work group and a desire for facilitative leadership style. METHODS: A quasi-experimental design was used to compare change over time in five-hospitals--an urban medical center, two community hospitals, and two rural hospitals. FINDINGS: Introduction of the model resulted in more favorable perceptions about the work group and a desire for a more facilitative nurse leader. CONCLUSION: Change in perception of work group and leader rather than job satisfaction may be an early indication of favorable outcome of planned change. Changes in nurse satisfaction may be a late outcome, which may be the reason findings from previous studies are mixed.

Attitude of Health Personnel↗
PubMed1995

Vascular access.

Explore the source record for details and available documents.

Catheters, Indwelling↗
PubMed1995

The nurse executive as multiple frame manager.

Determining the skills a nurse executive needs to be successful in today's changing health care market continues to be a popular focus for discussion and research. The use of multiframe organizational management, an approach previously unexplored with nurse executives, was the focus of a qualitative research study with five nurse executives practicing in a large midwestern metropolitan area. The study not only revealed how nurse executives use this skill in their everyday practice, but also provided a profile of how one nurse executive uses multiframe organizational management.

Adaptation, Psychological↗
PubMed1995

Implementation of a professional practice model for nursing in a rural hospital.

Growing concern about rural hospitals and the health of rural citizens highlight the need for high quality, progressive nursing care. To address this concern, several program changes to improve patient and organizational outcomes were made in one rural hospital; implementation success varied. Hospital culture and changes occurring within the health care environment affected the change process.

Continuity of Patient Care↗
PubMed1995

Characteristics of nephrology nurse researchers and their research.

OBJECTIVES: To identify the characteristics of nurses who are conducting research related to renal disease and the care of nephrology patients and to describe the investigations these researchers have conducted. DESIGN: Mailed survey using an investigator-adapted questionnaire, "ANNA Survey of Nephrology Nurse Researchers." SAMPLE/SETTING: Survey mailed to all 1991 members of ANNA's Research Special Interest Group and distributed via mail or at a nursing research conference to other nurses who were known to have conducted nephrology research. Ninety-six of the approximately 400 questionnaires that were distributed were returned; respondents described 147 research projects/programs of study. METHODS: Data were analyzed using descriptive statistics and chi-square analysis. RESULTS: Most respondents were master's prepared nurses who had completed one research study. Adults were the subjects in the majority of studies, and psychosocial phenomena and quality of life were the most frequently identified study foci. Descriptive and comparative studies were more common than experimental investigations. CONCLUSIONS: The findings indicate beginning exploration of a variety of patient care and administrative problems by nephrology nurses. Notably absent, however, was research on topics that present challenges to practicing nephrology nurses, including symptom management, care of diabetic and elderly renal patients, ethical issues, and cardiovascular complications of renal disease. Additional experimental research is needed, particularly to test nursing interventions aimed at alleviating common problems experienced by renal patients.

Humans↗
PubMed1994

Outpatient recovery after laparoscopic cholecystectomy.

Economic incentives and technologic advances have encouraged health care providers to shift an increasing portion of postoperative care out of the hospital. Selected patients undergo complex outpatient surgical procedures and are discharged within 24 hours of surgery. Because this trend is relatively new, published accounts of patients' experiences with at-home recovery are rare. Consequently, the authors conducted a qualitative study of 19 patients who underwent laparoscopic cholecystectomy procedures on an outpatient basis. Using semistructured postoperative telephone interviews, the authors monitored the patients' recovery processes. One theme (ie, toward a usual self) with two patterns (ie, progressive activity, self-management) emerged. The results reveal patients' definitions of recovery, understanding of postoperative instructions, willingness to ask questions, and advice for patients undergoing similar procedures. Nursing implications for discharge instructions and follow-up care also are discussed.

Adult↗
PubMed1993

Annotated bibliography: grant writing.

This is the first in series of annotated bibliographies on research topics that will appear in the ANNA Journal. The bibliographies have been prepared by members of ANNA's Research Special Interest Group. Each bibliography focuses on a particular topic and includes reviews of research books and articles published in nursing and allied health journals in recent years. The series is intended to assist nephrology nurse researchers in locating resources to plan and implement research studies and to communicate and implement research findings. The annotation for each item includes a full citation, a brief summary, and a categorization of the content level. The topic covered in this first bibliography is grant writing. Contributors to the grant writing bibliography were Nancy Hoffart, Janel Parker, and Nancy Seaby. The next installment will cover the research proposal, abstract writing, and the conceptual framework. Topics to be covered in future articles will include: (a) research proposal development and literature review; (b) poster preparation, abstract writing, and collaborative research; (c) instrument references, instrumentation, and reliability and validity; (d) research question, design and methods, and sampling; and (e) statistics and general nursing research texts. The following key was used in rating the content level for each citation: Basic/Introductory--For professionals who have no previous research background. Intermediate--For professionals who possess some knowledge of the research process and terminology, and have participated in some research projects. Advanced--For professionals who possess broad knowledge and experience with research projects.

Nursing Research↗
PubMed1992

Acute renal failure in bone marrow transplantation.

Acute renal failure (ARF) is a serious complication in clients who have undergone bone marrow transplantation (BMT). The majority of cases develop as a result of intrarenal damage. Renal ischemia or nephrotoxic drugs, free hemoglobin, and free myoglobin contribute to acute tubular necrosis (ATN), which is the most likely cause of ARF in BMT clients. Nursing care of hospitalized BMT clients is directed toward the prevention of ARF by identifying clients who are at risk, the early diagnosis of renal impairment, and the administration of comprehensive treatment. Nurses play a vital role in the early diagnosis of renal impairment by assessing the client's fluid status, serum and urine electrolyte levels, and daily weights. The nursing role in managing clients with ARF includes preventing drug nephrotoxicity, maintaining fluid and electrolyte balance, preventing infection, and providing emotional support.

Acute Kidney Injury↗