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PubMedDate not supplied

The effect of physician characteristics and their practice environment on surgical referral patterns for early-stage breast cancer in Iowa.

The objective of this article was to examine whether characteristics of referring physicians and their practice environment were associated with surgical referral behavior for early-stage breast cancer patients. A total of 2801 women diagnosed with early-stage breast cancer and their referring physicians were identified from the Iowa Surveillance, Epidemiology, and End Results (SEER) database during 1989-1996. The Iowa Physician Inventory was used to collect information on characteristics of referring physicians. Multiple logistic regression analyses were conducted to evaluate characteristics of the referring physicians and their practice environment to explain surgical referral behavior. Affiliation with physicians' networks and professional diversity among area specialists were associated with increased referrals to surgeons more likely to perform breast-conserving surgery. Promoting interaction among physicians, particularly among those with different specialties, may increase the diffusion of new behaviors into clinical practice.

Breast Neoplasms↗
PubMed1999

Screening mammography referral rates for women ages 50 to 69 years by recently-licensed family physicians: physician and practice environment correlates.

BACKGROUND: Physician mammography referral remains below optimal levels despite a long-standing recommendation that all women ages 50 to 69 years receive screening mammography every 1 to 2 years. The purpose of this study was to determine physician and practice environment predictors of family physicians' screening mammography referral rates to women ages 50-69 years. METHOD: A cohort of 498 recently-licensed family physicians was followed for 18-months of incipient medical practice. The referral rate was the percentage of new clinically eligible women patients seen in a primary care context who had a screening mammogram ordered by the study physician. Mammograms and independent variables were identified from physician claims to a Canadian universal health insurance agency. The effects of factors in a conceptual framework were assessed using multivariable linear regression. RESULTS: Correlates of higher mammography referral rates were female gender, better general prevention knowledge, the combination of comprehensive inquiry and continuity care, lower patient volume, and lower shared primary care (multivariable model R(2) = 0.47). Factors belonging to practice environment explained more of the observed variance than did physician characteristics. CONCLUSIONS: Mammography referral varies enormously and almost half of the variance is explained by physician characteristics and practice preferences. Higher mammography referral is observed in practices with more comprehensive and continuity care.

Adult↗
PubMedDate not supplied

Developing clinical practice environments supporting the knowledge work of nurses.

Registered nurses represent the largest group of healthcare knowledge workers. They accomplish their knowledge work by engaging in the roles of data gatherer, information user, knowledge user, and knowledge builder. To successfully implement these roles, nurses rely on healthcare settings to provide supportive clinical practice environments that recognize their information and knowledge management needs. The authors describe the various knowledge-worker roles, delineate computerized mechanisms that can support these roles, and examine the ability of current healthcare settings to provide an environment conducive to successful knowledge-worker role performance. The article concludes with specific recommendations for development of clinical practice environments supportive of nurses' knowledge work.

Decision Making, Computer-Assisted↗
PubMed2002

Measuring the hospital practice environment: a Canadian context.

The primary purpose of this study is to document the psychometric properties of the revised Nursing Work Index (NWI-R) in the context of a large Canadian sample of registered nurses. A self-administered survey containing the NWI-R was completed by 17,965 registered nurses working in 415 hospitals in three Canadian provinces. Using exploratory principal components analysis, with a forced one-factor solution, the practice environment index was obtained. In addition, key assumptions were tested from previous work about the rationale for the aggregation of NWI-R responses. In the Canadian context the one-factor solution provides a parsimonious index of the practice environment of registered nurses working in acute care hospitals. Further work is needed to determine the predictive capability of this index and its relevance to cross-national organizational contexts.

Acute Disease↗
PubMed1992

A center of nursing excellence: supporting the professional practice environment.

The Center of Nursing Excellence is a unique, multifaceted program that promotes the professional practice environment. The Center provides programs and services in six areas: career planning and development, nursing practice review, research and grants support, scholarly affairs, nursing outreach, and nursing resources. The Center serves as a resource to nurses at St. Louis Children's Hospital and in the nursing community at large.

Career Mobility↗
PubMed2004

Reshaping the practice environment: the importance of coherence.

Today's nurse leader is challenged to create a practice environment that fosters multidisciplinary collaboration, professional development, and a culture of safety. Fostering a sense of coherence among staff nurses about their place within the nursing department and the department's place within the broader organization id essential to the development of such environments. When nurses have a sense of coherence about their work setting, they are more likely to feel confident that their care of patients and families is fully supported by the organization in which they work. The authors describe the concept of coherence, discuss findings from a preliminary study regarding attributes that may contribute to coherence in individual nurses, and describe systems ans programs that have been implemented in a large academic medical center to foster a sense of coherence in individual nurses, the nursing department, and the institution as a whole.

Attitude of Health Personnel↗
PubMed1995

Total quality management: lessons learned from the medical practice environment.

Experience in dealing with the application of total quality management (TQM) to the medical practice environment suggests some generic lessons that can be helpful in applying TQM in other health care settings. These lessons focus on the need to address the motivation for TQM and its potential value; understanding the barriers created by the organizational and industry culture; identifying the structural barriers within the organization; clearly stating the guiding principles of the TQM effort; implementing the correct management tools for implementation; and allowing users of TQM to create new ideas for the application of TQM in their organizations.

Guidelines as Topic↗
PubMed1997

Restrictive practice environment and nurse practitioners' prescriptive authority.

This study analyzes the impacts of several variables, including a restrictive practice environment, on a nurse practitioner's level of autonomy with respect to prescribing selected categories of medicines. A general linear model is applied to data from the 1992 national sample of nurse practitioners. Results show that among the significant independent variables, a restrictive environment of imposed state laws and regulations reduces nurse practitioners' level of autonomy in prescribing medications and acts as a barrier to their practicing to full potential. Results and policy implications are discussed.

Drug Prescriptions↗
PubMed2001

Practice environments that attract and retain nurses.

Research shows that there is a direct correlation between the quality of nurses' work environments and the quality of client care. RNABC's newest policy statement, Nursing Practice Environments for Safe and Appropriate Care, identifies the key elements in an organization that are associated with improved client outcomes through attraction and retention of nurses.

British Columbia↗
PubMed1994

Longevity of dental restorations in selected patients from different practice environments.

The objective of the study was to evaluate the long-term survivals or longevity of dental restorations placed in selected patients from different practice environments in two countries. The case histories of 46 adult patients with 622 restorations placed in three private practices in Pakistan were followed for a minimum of 10 years, and compared with similar assessments of 50 adult patients with 966 restorations placed in a dental hospital in Australia. Amalgam and composite resin restorations showed similar survivals in both countries, but cast gold restorations had much lower survivals in the Pakistan group of patients. In both countries, restoration survivals were significantly better in females, and when patients attended less frequently for treatment. For the Australian group, changes in dental operators also gave significantly better survivals, and there were significant restoration survival differences present between the three practices in Pakistan.

Adult↗
PubMed1995

Creating an ethical practice environment: a focus on advocacy.

In order for nurses to be effective advocates, they must practice in an environment that fosters competency, collaboration, communication, and ethical values. This article addresses the meaning of advocacy, explores whether nurses can be effective advocates in complex practice environments, identifies barriers to advocacy, and suggests individual and systems approaches to support advocacy in critical care.

Critical Care↗
PubMed2005

Creating a favorable practice environment for nurses.

Chronic nurse turnover and attendant personnel shortages threaten patient care. Inadequate pay and benefits are primary factors leading to nurses' job dissatisfaction and, subsequently, to turnover. However, recent meta-analyses suggest that a favorable practice setting can improve nurses' satisfaction and minimize turnover. The practice environment's potential to positively influence nurses' job satisfaction is analyzed in a large academic medical center. Nurse supervisors, job characteristics, management style, and service quality emphasis--not just money and benefits--surface as key factors associated with a positive practice milieu. Implications for raising nurses' job satisfaction, reducing turnover, and improving care delivery are discussed.

Attitude of Health Personnel↗
PubMedDate not supplied

Shared governance and the nursing practice environment.

An evaluation of the impact of shared governance on staff nurse perceptions of management style, group cohesion, job stress, job satisfaction, and anticipated turnover provides support for claims that shared governance improves the nursing practice environment.

Attitude of Health Personnel↗
PubMedDate not supplied

Relationships of work and practice environment to professional burnout: testing a causal model.

BACKGROUND: Research has established clear links between nurses' experience of professional burnout and many qualities of work environments but more work is needed to clarify interrelationships among aspects of complex organizational settings. OBJECTIVE: To test a nursing worklife model that defined structured relationships among professional practice environment qualities and burnout. METHODS: Hospital-based nurses in Canada (N = 8,597) completed an assessment of worklife (Nursing Work Index, NWI) and burnout (Maslach Burnout Inventory-Human Service Scale, MBI-HSS). RESULTS: A causal model was used to confirm the factor structure of the Professional Environment Scale (NWI-PES) on a subset of NWI items and the factor structure of the MBI-HSS. The analysis provided support for a structural model (nursing worklife model) linking the five worklife factors used to define a fundamental role for nursing leadership in determining the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care, and physician-nurse relationships. The analysis supported a direct path (negatively weighted) from staffing to emotional exhaustion and a direct path (positively weighted) from nursing model of care to personal accomplishment. DISCUSSION: Implications for refining a model of worklife are discussed. Implications for enhancing the quality of worklife and supporting engagement with work are considered.

Adult↗
PubMed2006

Comfort Theory: a unifying framework to enhance the practice environment.

The application of theory to practice is multifaceted. It requires a nursing theory that is compatible with an institution's values and mission and that is easily understood and simple enough to guide practice. Comfort Theory was chosen because of its universality. The authors describe how Kolcaba's Comfort Theory was used by a not-for-profit New England hospital to provide a coherent and consistent pattern for enhancing care and promoting professional practice, as well as to serve as a unifying framework for applying for Magnet Recognition Status.

Accreditation↗
PubMed2000

Strategic planning: a modern tool for obstetricians and gynecologists in a competitive practice environment.

The now inevitable changes in health care practice and financing have resulted in missed opportunities for physician directed improvements in medical and surgical care of patients. The process of strategic planning is the business tool that allows individuals and organizations to assess proactively the need for change and allows them to adapt and respond appropriately to a changing environment. The fundamental components of implementing a strategic plan include assessing environmental and organizational factors, defining strengths and limitations of the organization, identifying a market niche if possible, and, after establishing key objective and goals, periodically reviewing the plan to determine that goals are attained. Future success in health care will likely depend upon the ability to effectively anticipate, plan, and implement necessary changes.

Journal Article↗
PubMed1989

The new medical practice environment. Internists' view of the future.

There have been many changes in the environment in which internal medicine is practiced in recent years. This has been coupled with reports of internists becoming frustrated and of internists leaving primary care practice. We conducted a survey of 219 internists in academic and private practice in western New York. While internists were generally positive regarding the training of residents, there was a pervasive feeling of frustration and demoralization among practicing internists. This demoralization may affect recruitment of new physicians to internal medicine and cause early retirement of practicing internists. The study demonstrated some of the causes of the demoralization.

Adult↗