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At least 253 records · Page 14Linked to original sources
PubMed1998

Illuminating the 'black box'. A description of 4454 patient visits to 138 family physicians.

BACKGROUND: The content and context of family practice outpatient visits have never been fully described, leaving many aspects of family practice in a "black box," unseen by policymakers and understood only in isolation. This article describes community family practices, physicians, patients, and outpatient visits. METHODS: Practicing family physicians in northeast Ohio were invited to participate in a multimethod study of the content of primary care practice. Research nurses directly observed consecutive patient visits, and collected additional data using medical record reviews, patient and physician questionnaires, billing data, practice environment checklists, and ethnographic fieldnotes. RESULTS: Visits by 4454 patients seeing 138 physicians in 84 practices were observed. Outpatient visits to family physicians encompassed a wide variety of patients, problems, and levels of complexity. The average patient paid 4.3 visits to the practice within the past year. The mean visit duration was 10 minutes. Fifty-eight percent of visits were for acute illness, 24% for chronic illness, and 12% for well care. The most common uses of time were history-taking, planning treatment, physical examination, health education, feedback, family information, chatting, structuring the interaction, and patient questions. CONCLUSIONS: Family practice and patient visits are complex, with competing demands and opportunities to address a wide range of problems of individuals and families over time and at various stages of health and illness. Multimethod research in practice settings can identify ways to enhance the competing opportunities of family practice to improve the health of their patients.

Adult↗
PubMed2001

The role of the clinical nurse specialist in creating a healthy work environment.

The clinical nurse specialist (CNS) contributes to a healthy work environment through partnerships with the nursing staff, nurse manager, physicians, and other colleagues across the health system. Examples of these partnerships are described in this article, highlighting how the work of the CNS influences the care that patients and families receive, shapes the practice environment, and fosters collegial and respectful relationships among caregivers. The CNS is a pivotal figure in creating an environment where nurses can provide the care that is needed and feel valued for their work. Partnership with a variety of clinicians enables the CNS to influence critical care nursing practice, the intensive care unit team, and the environment in which care is provided.

Education, Nursing, Graduate↗
PubMed1996

A field trial of the NASA Telemedicine Instrument Pack in a family practice.

BACKGROUND: Previous studies of telemedicine applications have demonstrated that the technology is effective but inefficient. Little attention has been directed to the primary care portion of the connection, especially the use of the medical peripheral devices. This study used a telemedicine testbed that simulates a rural practice environment to describe the effectiveness and efficiency of the NASA Telemedicine Instrument Pack, a small self-contained system of medical peripheral devices. METHOD: This study was an 8-week field trial of a suitcase-sized pack containing a fundus camera, flexible nasopharyngoscope, dermatology macrolens, light source, and video monitor. The pack was first studied in specialty clinics and then was used in a family practice office connected to the consultant node by digital lines. Evaluations were obtained from technicians, patients, and consultants. RESULTS: During 20 video clinic sessions, 59 patients with 38 different diagnoses were examined. The ear, nose, and throat portion of the exam was effective, with some decrement in color and clarity with compression of the signal. The eye portion was marginally effective, limited by a field of view that was too narrow and also by rigorous technician requirements. The skin exam was largely unacceptable primarily because the macrolens did not meet the requirements for color or clarity prior to compression of the signal. CONCLUSIONS: Subsequent design efforts for medical peripheral devices for telemedicine use will require significant modifications to "off the shelf" equipment to be effective and efficient. A family practice telemedicine testbed provides the appropriate environment for such field trials.

Attitude of Health Personnel↗
PubMedDate not supplied

Telehealth's impact on nursing and the development of the interstate compact.

The information age has opened a new era for nursing practice. Advances in telecommunications technology now allow nurses to care for patients and their families in geographic locations throughout the country. This new practice environment challenges many of the assumptions that have created a state-based system of nurse practice acts and licensing. In response to this challenge, the creation of a new mechanism for licensure and practice, the interstate compact, is developing. In this article, the development and regulatory challenges created by telenursing and the interstate compact are discussed.

Humans↗
PubMedDate not supplied

Physician and staff turnover in community primary care practice.

The effect of a rapidly changing healthcare system on personnel turnover in community family practices has not been analyzed. We describe physician and staff turnover and examine its association with practice characteristics and patient outcomes. A cross-sectional evaluation of length of employment of 150 physicians and 762 staff in 77 community family practices in northeast Ohio was conducted. Research nurses collected data using practice genograms, key informant interviews, staff lists, practice environment checklists, medical record reviews, and patient questionnaires. The association of physician and staff turnover with practice characteristics, patient satisfaction, and preventive service data was tested. During a 2-year period, practices averaged a 53% turnover rate of staff. The mean length of duration of work at the current practice location was 9.1 years for physicians and 4.1 years for staff. Longevity varied by position, with a mean of 3.4 years for business employees, 4.0 years for clinical employees, and 7.8 years for office managers. Network-affiliated practices experienced higher turnover than did independent practices. Physician longevity was associated with a practice focus on managing chronic illness, keeping on schedule, and responding to insurers' requests. No association was found between turnover and patient satisfaction or preventive service delivery rates. Personnel turnover is pervasive in community primary care practices and is associated with employee role, practice network affiliation, and practice focus. The potentially disruptive effect of personnel turnover on practice functioning, finances, and longitudinal relationships with patients deserves further study despite the reassuring lack of association with patient satisfaction and preventive service delivery rates.

Humans↗
PubMed2006

Dispersion of exhaled droplet nuclei in a two-bed hospital ward with three different ventilation systems.

UNLABELLED: Effective ventilation in general hospital wards is important for controlling the airborne transmission of infectious respiratory diseases. Experiments have been carried out to increase our understanding of the interaction of the breathing flows of two individuals in a full-scale experimental hospital ward with three ventilation systems, i.e. mixing, downward and displacement ventilation. Two life-size breathing thermal manikins were used to simulate a source patient and a receiving patient. The exhalation jet from a bed-lying manikin was visualized using smoke. N2O was used as tracer gas to simulate the droplet nuclei exhaled by patients; and the spatial distribution of its concentrations was measured. Our experimental results show that for both mixing and downward ventilation, the exhaled jet penetrates a short distance and is diluted quickly by ventilation air. The exhaled droplet nuclei are well mixed in the ward. Bed distance does not affect the personal exposure of the receiving patient. For displacement ventilation, the exhaled jet can penetrate a long distance. A high concentration layer of exhaled droplet nuclei because of thermal stratification locking has also been observed with displacement ventilation. This work is useful for identifying an appropriate ventilation method that can remove droplet nuclei more effectively and minimize the risk of cross-infections in a hospital ward environment. PRACTICAL IMPLICATIONS: As one of the major potential sources for infectious droplet nuclei in a hospital environment, exhalation flows of an infected patient can interact with the respiratory activities of other close individuals and with the room ventilation systems. Our latest results provide information on the penetration of exhalation jets into the ambient environment in different ventilation systems. This work is useful in identifying an appropriate and effective ventilation method for removing droplet nuclei more effectively, and thus minimizing the risk of cross-infections in hospital wards with multiple beds.

Air Movements↗
PubMedDate not supplied

Workplace empowerment and magnet hospital characteristics: making the link.

OBJECTIVE: To test a theoretical model linking nurses' perceptions of workplace empowerment, magnet hospital characteristics, and job satisfaction in 3 independent studies of nurses in different work settings. BACKGROUND: Strategies proposed in Kanter's structural empowerment theory have the potential to result in work environments that are described in terms of magnet hospital characteristics. Identifying factors that contribute to work conditions that attract and retain highly qualified committed nurses, such as those found in magnet hospitals, that can be put in place by nursing administrators is extremely important for work redesign to promote professional nursing practice. METHODS: Secondary analyses of data from 3 studies were conducted--2 of staff nurses and 1 with acute care nurse practitioners working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire-II, the NWI-R, and measures of job satisfaction were used to measure the major study variables.RESULTS The results of all 3 studies support the hypothesized relationships between structural empowerment and the magnet hospital characteristics of autonomy, control over practice environment, and positive nurse-physician relationships. The combination of access to empowering work conditions and magnet hospital characteristics was significantly predictive of nurses' satisfaction with their jobs. CONCLUSIONS/IMPLICATIONS: These findings suggest that nursing leaders' efforts to create empowering work environments can influence nurses' ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes.

Adult↗
PubMed2002

Nosocomial infections: important acute care nursing-sensitive outcomes indicators.

Clinical and cost burdens related to nosocomial infections continue to plague the US healthcare system. Vulnerable populations, such as the elderly and the immunocompromised are especially at risk. Current evidence suggests that because hospital stays are shorter, nosocomial infection rates per 1000 patients have actually increased. Nosocomial infections, specifically bacteremias, have been targeted by the American Nurses Association as outcomes that can be affected by nursing in acute care settings. Nursing staffing and practices recently have been linked to the incidence of nosocomial infections. Participation in national databases and benchmarking techniques can provide data-based evidence that nursing practice influences nosocomial infections. Advanced practice nurses are key to ensuring that evidence-based practice environments, in which data drive decision-making, can flourish so that nurses can identify and implement practices that can reduce the rates of nosocomial infections.

Bacteremia↗
PubMed2001

How does a changing country change family practice?

The US population is changing. Ethnic minorities are now the fastest growing segment of the US population, and they have higher mortality rates than the remainder of Americans. Members of minority groups also earn less and are twice as likely as other residents to lack medical insurance. Minority communities have poorer health and access to care than the remainder of the population. Women constitute more than half the total population of the United States and are half of the labor force. Family structure has changed such that 53% of African-American, 32% of Hispanic, and 27% of all families were headed by a single parent in 1992. The elderly population has also increased and has a greater prevalence of chronic disease. The physician workforce has more female and younger physicians than in the past but a still-inadequate number of minority physicians. In contrast to the low proportion of minorities in the US physician workforce, women now comprise approximately half of medical students. A major economic trend affecting health care access in the United States is the lack of secure insurance coverage for 44 million people in 1998. Rates of no insurance are higher among minorities, households with no full-time worker, the near poor, and among persons with less education. Private charitable services, as well as the formal safety net systems, are experiencing financial pressure in the United States, further jeopardizing access to care for the uninsured. The average family in the United States is now working harder--but earning less money. The changing population mix, shifting gender balance, increasing proportion of elderly, and major socioeconomic trends and income disparities occurring in the United States today have shaped a practice environment that differs from whatfacedfamily physicians 30 years ago. Thus, a change in approach to training and practice is needed, while preserving the critical relationship we have with our patients and continuing to meet their needs.

Education, Medical↗
PubMed1997

Retraining physicians for primary care. A study of physician perspectives and program development.

OBJECTIVE: To determine the number and kinds of programs that medical schools and managed care organizations offer or plan to offer to retrain physician specialists to practice primary care medicine and to discover physicians' attitudes toward such retraining. DESIGN: A survey was mailed in 1994 to all 126 medical schools and the 19 largest US managed care organizations to collect detailed information about existing and potential retraining programs. Physicians' attitudes toward retraining were elicited from participants in 3 geographically diverse focus groups. Selected specialists were polled through the national survey of the American Medical Association's Socioeconomic Monitoring System to ascertain the demand for retraining. RESULTS: The majority of institutions contacted perceived a need for retraining, but few programs had been established. Programs being "considered" varied widely in duration, class size, target audience, accreditation, and projected training settings. Although unenthusiastic about retraining, physicians preferred programs that would expand their patient base, maintain the practice population, be inexpensive and close to home, and provide hands-on training in the eventual practice environment. Physicians also preferred a goal-oriented, part-time retraining program in a large group practice or managed care setting that would allow them to practice their specialty while retraining. Few planned or existing programs incorporate many of these features. The most likely candidates for retraining are subspecialty physicians who currently provide some primary care and are employed by a medical plan. CONCLUSIONS: Despite efforts by those who perceive that a need for more generalist physicians is stimulating interest in retraining specialists and subspecialists to provide primary medical care, physician interest and program availability remain low, and programs under development are not being designed to attract those who may seek retraining. This situation is probably fortuitous, because changed perceptions about the adequacy of the generalist physician workforce since the beginning of this study have diminished the call for retraining.

Adult↗
PubMed1998

Project 2000 diplomates' perceptions of their experiences of transition from student to staff nurse.

This paper presents findings from an exploratory study of the transition experiences of newly qualified Project 2000 diplomates. A qualitative approach was utilized involving in-depth interactive interviews with a sample of 10 staff nurses. The data indicate that some aspects of transition were initially difficult, but that all those interviewed were enjoying nursing. Similarities to the experiences of 'traditionally prepared' colleagues are highlighted by the use of phrases such as 'in at the deep end' and 'cast adrift', reflecting the practice environment once qualified. Paradoxically initial transition for Project 2000 diplomates is characterized by a lack of confidence, while their questioning approach to practice and a willingness to ask others when unsure ('no bluffing') suggests a high degree of confidence. Preceptorship in the context of a supportive environment is suggested as a model for easing the transition process. A re-evaluation of what an initial preparation course can and should achieve, and a re-assessment of the skills and knowledge expected of newly qualified nurses, are also indicated.

Attitude of Health Personnel↗
PubMed2002

Policy requirements and performance indicators for good practice in health, environment and social management in the enterprises.

This paper presents the concept and objectives of good practice in health, environment and social management in enterprises (GP HESME). Major criteria for establishing this approach and possible indicators to assess progress at the enterprise and municipal level are also outlined. Employers and employees make a huge number of decisions at work which have an influence on the use of natural resources, the ambient environment, quality of living and working environment, work organization and work cultures. These decisions have an obvious impact on their own health as well as on that of their families, neighbours and customers. Recognizing that, the Third Ministerial Conference on Environment and Health noted in June 1999 in the London Declaration the need for development of a holistic concept of good practice in health, environment and safety management in enterprises. In response to this request the WHO Regional Office for Europe, working jointly with governmental and non-governmental experts, scientists and practitioners, has developed the new concept of workplace health.

Decision Making↗
PubMedDate not supplied

A national survey of infection prevention practices on bone marrow transplant units.

PURPOSE/OBJECTIVES: To identify and describe bone marrow transplant (BMT)-specific infection prevention measures in the United States. DESIGN: Survey design using a mailed questionnaire. SETTING: BMT programs across the United States. SAMPLE: 91 BMT programs (80.5% response rate). METHODS: A questionnaire containing both closed- and open-ended items was mailed to identified nurse contacts following introductory phone calls. Descriptive statistics were computed on responses to closed-ended questions; content analysis was performed on responses to open-ended questions. FINDINGS: Although all programs used some type of protected environment, practices varied considerably. Wide variation existed in cover-garment and hand-washing practices, regardless of the type of protected environment in use. Other protective measures included skin decontamination (69%), gut decontamination with oral nonabsorbable antibiotics (30%), antifungal therapy (73%), acyclovir therapy (82%), immunotherapy (73%), granulocyte-macrophage colony stimulating factor therapy (58%), and modified microbial diets (66%). Numerous mouth care regimens, visitor and patient precautions, and environmental maintenance routines were described. CONCLUSION: Little standardization of infection-prevention practices exists nationwide. IMPLICATIONS FOR NURSING PRACTICE: Efforts should be made to test the cost effectiveness and benefits of the various measures in use prior to the development of national standards.

Anti-Bacterial Agents↗
PubMed1991

[Veterinary practice and the environment: what to do and what to omit].

A veterinary practice supplies services and goods, both sections involving acts affecting the environment. Until recently, little attention was paid to the environment, but today far more is known concerning the manner in which veterinary practices should handle the environment. Among other things, this paper will be concerned with the groups of various substances which constitute a menace to the environment, the relevant environmental policy as well as the approach to environmental policy in practice and to the function of the veterinary surgeon as distributor of veterinary drugs respectively. Instruction of the users of veterinary drugs as regards storage and exposure to pollution are discussed. Finally, the economic aspects of a modern environmental policy in veterinary practice are referred to.

Environmental Pollution↗
PubMedDate not supplied

Perceptions of barriers to psychiatric-mental health CNS practice.

This descriptive study of practice barriers compared the perceptions of 67 psychiatric/mental health clinical nurse specialists (PMH-CNSs) with those of 767 nurse practitioners (NPs) in a single state. In addition, it contrasted the barriers identified by the rural and urban PMH-CNS study participants (n=14 and 53, respectively). Though all participants found the practice climate moderately restrictive on a 5-point Likert scale (1=very restrictive to 5=not restrictive), the PMH-CNSs found the practice environment significantly more restrictive than the NPs (3.13 versus 3.61, p<.001). Lack of public knowledge of their advanced practice role was the top-ranking practice barrier for both NPs and PMH-CNSs (60% and 44%, respectively). Lack of understanding of their role was the next highest in rank (PMH-CNSs at 49%; NPs at 39%). CMH-CNSs noted resistance from physicians and/or psychologists as their third-highest barrier (42%); the NPs did not rank this barrier in their top five. Rural PMH-CNSs perceived a lack of a peer network as a considerable barrier (57%); however, urban PMH-CNSs did not rank this in their top barriers, indicating that rural professional isolation needs to be addressed. These findings indicate that efforts to educate the public and other professionals about advanced practice nursing roles and issues must be a priority, and other barriers such as salary and isolation continue to hamper the role success of PMH-CNSs.

Attitude of Health Personnel↗
PubMed1991

Time to adoption of an innovation by dentists in private practice: sealant utilization.

Dentists can be divided into five adoption categories based upon their time of adoption of pit and fissure sealants: innovators, early adopters, early majority, late majority, and laggards. The differences among dentists in the five adoption categories were examined for four classes of variables: practice characteristics, dentist characteristics, communication of information, and practice environment. Questionnaires were mailed in September 1984 to a random sample (N = 521) of Washington State dentists in general practices. A total of 376 completed questionnaires were returned, for a response rate of 72 percent. Adoption of sealants proceeded as follows: 5 percent of dentists through 1973, 24 percent through 1979, 50 percent through 1982, and 75 percent through 1984. Adoption category was related to percent of assistants who were certified, delegation to assistants and hygienists, magnitude of the fees charged by the practice, number of staff meetings per month, the dentist having been an officer in a dental organization, year the dentist adopted other new technologies, dentist's self-rating of willingness to try new things, percent of patients who are children, and percent of the dentist's colleagues who used sealants. These data lend some support to the two-stage or opinion-leader model of diffusion and suggest that new technologies can be promoted by first influencing dentists who consistently adopt early.

Adolescent↗
PubMed2006

Considerations for adolescent integrative health care in Canada.

The increased use of complementary/alternative medicine (CAM) has stimulated practitioners, policy makers, and researchers to examine its integration into mainstream medicine. For adolescents, there is evidence that they are using CAM as an option for health care. However, there is limited information on how adolescent integrative care should be developed in Canada. Practice, practice environments, and education are the three areas identified in which modifications should be made to current adolescent-focused practice in Canada to make it more of an integrative system.

Adolescent↗