Rural hospitals are burdened by inadequate reimbursement, low occupancy rates, high numbers of uninsured patients, and uncompensated care. The authors present an innovative solution, the Clinical Care Coordination Program, to uncompensated care related to prolonged length of stay in a 188-bed rural hospital. The authors discuss the rationale for the development of the program and the steps used to develop it. Evaluation of the Clinical Care Coordination Program demonstrated statistically significant decrease in length of stay for the services involved in the program. Further evaluation of the responses of persons involved in the program or affected by it also are positive.

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Nurses and Public Law 102-119: a family-centered continuing education program.

The passage of Part H of the Education of the Handicapped Act, Public Law 99-457, and the reauthorization of the law in 1991, as Public Law 102-119, mandates a family-centered approach to the provision of services to infants and young children with handicaps. Nurses are named as providers in this federal legislation. The authors conducted a survey to assess the learning needs of nurses who may wish to serve as providers under the law. The survey results were used to develop a family-centered continuing education curriculum that pairs parents and nurse faculty as partners in delivering the curriculum.

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The needs of patients with cancer and their caregivers in rural areas.

PURPOSE/OBJECTIVES: To describe physical and psychological needs, rank their importance, and identify needs that were not met of patients with cancer and their caregivers living in rural settings. DESIGN: Exploratory descriptive. SETTING: Rural Vermont. SAMPLE: 30 patients with cancer and 30 caregivers. METHODS: Patients completed the self-administered. 104-item Patient Needs Scale; caregivers completed the self-administered, 90-item Caregiver Needs Scale. Respondents were asked to rate the importance of an item on a scale of 1-10 if they considered if a need. If a numbered item was scored, respondents identified whether the need was met. FINDINGS: The patient group identified 49% of scale items as needs; the caregiver group identified 41% of scale items as needs. Greater than 50% of the patient and caregiver respondents identified needs in areas of personal care. Involvement with health care, and interpersonal Interaction as very important. The patient group reported that 5% of identified needs were unmet, whereas the caregiver group reported that 14% of identified needs were unmet. CONCLUSIONS: In rural settings, caregiver needs, while fewer in number, are not met three times more frequently than patient needs. IMPLICATIONS FOR NURSING PRACTICE: The needs identified by more than 50% of both groups should be included in assessment and care plans. The variability of patient and caregiver needs reinforces the importance of individual assessment and planning rather than making assumptions about needs. Future research may include identifying questions to elicit current needs and determining how often these questions should be asked to meet changing needs.

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