SEARCH · PubMed Health

Results for “practice environment”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources

PubMed2006

Palliative care consultation in the intensive care unit.

Deaths occur frequently in the intensive care unit, yet clinicians in this unique practice environment are often untrained in the care of patients who are dying. Palliative care consultation in the intensive care unit may bridge the gaps between what should be done for dying patients and their families and what is often the default, that is, a prolonged death with inadequate symptom management and not enough family support. Hospital-based palliative care consult services have demonstrated positive patient-assessed and system outcomes, including symptom management, family support, reductions in hospital length of stay, increases in discharge home with hospice referrals, and reduced costs of care. Similar outcomes have been reported about intensive care unit-focused palliative care consultation. Palliative care consultants who seek referrals from the intensive care unit will be successful if strategies such as getting acquainted, learning about the environment and patterns of care, seeking feedback, and respecting the intensive care unit's life-saving efforts are employed. Intensive care staff satisfaction with palliative care consultation will drive future referrals.

Decision Making↗

PubMed2006

An evaluation of the role of the clinical education facilitator.

AIMS AND OBJECTIVES: The objective of the study was to identify whether clinical education facilitators made a difference to the learning experiences of nurses in a large teaching hospital. BACKGROUND: Strategies for enabling continuous professional development are well established in health care organizations as key components of approaches to lifelong learning. The benefits of continuous professional development include the maintenance of high standards of care, the improvement and development of services, ensuring the competency of all nursing staff and guaranteeing the accountability of nurses for their actions. The role of clinical education facilitator is relatively new and little evaluation of this role has been undertaken. CONCLUSIONS: This study highlights important issues to be considered in developing a 'learning culture' in a hospital organization, through the adoption of such roles as clinical education facilitators. Whilst the roles have had an important function in the active coordination of learning activities in the hospital, there is little evidence of the role directly impacting on the learning culture of clinical settings. Learning mechanisms have been identified. The results of this evaluation can be subjected to further testing through ongoing evaluation of the outcomes arising from the learning mechanisms in place. Given the emphasis on work-based learning and continuing professional development in health care, then this ongoing evaluation can yield important information about future directions for nurse education. RELEVANCE TO CLINICAL PRACTICE: The study highlights the importance of supported learning in the workplace. However, more importantly, it identifies the need for a culture of professional practice to be developed in order to sustain learning in practice. Classroom-based learning alone, cannot create a culture of development in nursing and there is thus a need for models of work-based learning to be integrated into practice environments.

Attitude of Health Personnel↗

PubMed1997

Changing handover practices: one private hospital's experiences.

The handover practice has long been an important component of clinical nursing practice allowing nurses to exchange relevant client information from one shift to the next and ensure continuity of patient care. Traditional approaches have seen nursing handovers taking place in a room away from general ward activity. Oncoming nursing staff receive the information verbally from nurses on the previous shift about all patients within the ward or unit. This practice has been proven over time to present difficulties and consequently, many hospitals are choosing to adopt models that better address current needs. This analysis describes the creative approaches taken by one private hospital in modifying handover practices with the view to reduce time and increase overall efficiency and effectiveness, whilst ensuring that staff and ward requirements are considered. The study highlights how action research principles can be applied to introduce change into the clinical practice environment.

Communication↗

PubMed2004

Pedagogical integrity in the knowledge economy.

Abstract In pedagogy, as in life generally, there are moral complexities and ambiguities intrinsic to the teaching-learning process. Within the context of the knowledge economy and globalization those complexities and ambiguities are proliferating. How we as educators address the interface between these complexities is critical to how well we and those we serve fare in the educational and practice environment. With the emergent corporate university culture it would seem that the major goal is to become a 'knowledge factory' or a site of knowledge creation. Increasingly its scientific and technological agenda is to focus on generating knowledge that would further the means and ends of economic growth and public policy. Traditionally, however, education has meant much more than this. Indeed, the original purpose of university education was designed to foster a desire for right conduct and good things which ultimately cannot be neatly packaged and delivered. Within this view, university educators would thus be expected to cultivate a climate of self-reflection in which learning can be fulfilling in itself. This paper explores the notion of globalization and its hegemonic influence on the university agenda and addresses how corporatism, a key dimension of globalization, is in effect usurping the very essence of the teaching-learning process.

Ethics, Professional↗

PubMed2006

Properties of a Norwegian version of the Ward Organisational Features Scales.

To assess the association between nurses' practice environment and established measures of discharged patients' experiences during hospitalisation it is necessary to have a validated instrument to collect data on nurses' work environment in hospital wards. The purpose of this study was to assess the reliability and validity of a Norwegian version of the Ward Organisational Features Scales (WOFS), an instrument developed in the UK to describe environmental factors influential on the effectiveness of nursing services. After linguistic adaptation of the questionnaire, the reliability and validity were assessed in a sample of 99 nurses, of whom 46 (45%) responded. Most of the 12 tested scales showed acceptable internal consistency (10 had Cronbach's alpha > 0.70) and test-retest reliability (eight had intraclass correlation coefficient >0.70). The WOFS scales' correlations with external variables were in line with hypothesised correlations, thus supporting their validity. Scales describing nurses' influence on ward organisation and management did not perform well, probably due to differences in intraward organisation in the two countries. In spite of a limited sample size this study suggests that the majority of the scales of the WOFS showed satisfactory psychometric properties. They can be useful for assessing and describing aspects of nurses' work environment in Norwegian hospitals.

Adult↗

PubMed2004

External validity, generalizability, and knowledge utilization.

PURPOSE: To examine the concepts of external validity and generalizability, and explore strategies to strengthen generalizability of research findings, because of increasing demands for knowledge utilization in an evidence-based practice environment. FRAMEWORK: The concepts of external validity and generalizability are examined, considering theoretical aspects of external validity and conflicting demands for internal validity in research designs. Methodological approaches for controlling threats to external validity and strategies to enhance external validity and generalizability of findings are discussed. CONCLUSIONS: Generalizability of findings is not assured even if internal validity of a research study is addressed effectively through design. Strict controls to ensure internal validity can compromise generalizability. Researchers can and should use a variety of strategies to address issues of external validity and enhance generalizability of findings. Enhanced external validity and assessment of generalizability of findings can facilitate more appropriate use of research findings.

Data Collection↗

PubMed1999

Prediction of resource utilization and case cost for acute nonvariceal upper gastrointestinal hemorrhage at a Canadian community hospital.

OBJECTIVE: Upper gastrointestinal hemorrhage (UGIH) is common, and thus imposes a substantial burden on health care resources. We describe resource utilization and cost for management of acute nonvariceal UGIH, and studied their variation among population subgroups. METHODS: Resource utilization and direct medical case costs were extracted for consecutive admissions for nonvariceal UGIH at a large community hospital in southern Ontario through chart review and adaptation of an administrative case cost database. Univariate and multiple regression models were then developed to identify independent demographic predictors of case cost and length of stay. RESULTS: Among 116 eligible admissions the average length of stay and case cost were 4.26 days and Can$2690, respectively (Can$1 = US$0.70). Both cost and length of stay demonstrated significant univariate relationships with age, comorbid illness, prior peptic ulcer disease (PUD), and prior UGIH. Age and prior PUD persisted as independent predictors in multiple regression models. An inverse transformation of total case cost allowed these variables to explain 26% of the total variance. CONCLUSIONS: Resource utilization for management of acute nonvariceal UGIH at a Canadian community hospital varies substantially among population subgroups, but correlates independently with age and prior ulcer history. Careful attention must be paid to practice environments and demographic profiles before economic models of strategies to prevent or treat UGIH are applied to specific subpopulations.

Acute Disease↗

PubMed1984

An investigation into the response of subjects to a plaque control programme as influenced by friends and relatives.

The aim of the present study was to assess the response of patients to a course of instruction in plaque control as influenced by friends and relatives. The subjects in the study were 41 patients who had been referred to a dental hospital for treatment. There was a major reduction in plaque and gingivitis levels in the subjects at both the 10th and 14th weeks of the study. There was a greater proportional reduction in gingivitis levels in those subjects who had a higher number of reported discussions with their friends. The effect of discussions with members of the family was less clear. Lower values for gingivitis levels at 10 weeks were associated with a higher number of discussions with parents. However the levels of gingivitis tended to be adversely affected by discussions between the subjects and their spouses. The importance of recognising the influence of family and friendship networks needs to be understood when preventive programmes are designed, especially where high levels of self-care are sought as outcomes. Further work is in progress on a group of office workers being treated in a dental practice environment. This will allow the type of advice being obtained from the various contacts to be investigated in more detail.

Adult↗

PubMedDate not supplied

Faculty and student dialogue through journal writing.

ISSUES AND PURPOSE: To explore how journal writing promotes and fosters an ongoing dialogue between students and faculty during an acute care pediatric clinical experience. DESIGN AND METHODS: Unstructured, self-report data were collected via students' clinical journal entries and during a focus group interview. Content analysis was used to identified recurrent themes. RESULTS: Two themes were generated: building a bond of trust and saving face. PRACTICE IMPLICATIONS: The findings have implications for preceptors of nursing professionals. Implementing journal writing as a component to teaching-learning in the practice environment provides a means to recognize the affective outcomes of learning, such as increasing self-awareness and professional growth.

Adaptation, Psychological↗

PubMed2004

How safe is the safety paradigm?

This paper reviews safety initiatives in the health systems of the UK, Canada, Australia, and the US. Initiatives to tackle safety shortcomings involve public-private collaborations. Patient safety agencies (to institute learning, action and safety culture), adverse event reporting and, to a lesser extent, safety related performance indicators are currently used to design safer health systems. Their benefits are mixed, but there is little debate as to their possible side effects. Foreseeable adverse effects of multiple safety organisations stem from them being too many, too vague, too narrowly focused, threatened by the medical practice environment, and too optimistic. Safety related performance indicators are most developed in the US but suffer from inadequacies of administrative data, underreporting, variable indicator definitions, "extended" use, and low sensitivity of the diagnosis coding system, and arguable preventability of the prescribed conditions. A critical appraisal of the implications of these deficiencies is important to assure the safety of current health system safety initiatives and to establish evidence based safety. It is necessary to embed health system safety (as well as patient safety) in the societal culture, structures, and policies which promote effective, user centred, high performance care while allowing for healthy innovation.

Australia↗

PubMed2004

The human factor: the critical importance of effective teamwork and communication in providing safe care.

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

Communication↗

PubMed2006

Impact of nursing on hospital patient mortality: a focused review and related policy implications.

Understanding the determinants of patient mortality can lead to the development of strategies that reduce mortality and prevent unnecessary death. This paper synthesizes the body of published research that explores determinants of mortality for patients who have experienced acute care hospitalization. Fifteen research manuscripts were found to meet the selection criteria through an electronic search in MEDLINE and CINAHL (1986-2004). Seven categories of determinants of mortality were found: nurse-physician relationships, nurse staffing characteristics, physician characteristics, professional practice environment, nurse experience, registered nurse educational preparation, and clinical nursing support. Implications and recommendations for improving quality and safety in hospital care are discussed.

Cross-Over Studies↗

PubMed2005

Multi-institutional analysis of computed and direct radiography: part II. Economic analysis.

PURPOSE: To compare economic aspects of equipment configurations, productivity levels, and patient waiting times in the performance of computed radiography (CR) and direct radiography (DR). MATERIALS AND METHODS: The study received internal review board exemption status, without the need for informed patient consent. Data from four study sites were used to calculate the CR-DR crossover point (defined as the point at which the cost-effectiveness of DR equals that of CR) and CR-DR annual cost differentials. Analyzed variables included equipment and operating costs, examination volumes, and productivity. A program was developed to simulate patient arrival times, number of patient examinations, and patient waiting times on the basis of average annualized parameters for each of the four clinics. Sensitivity analyses were conducted to assess utilization rates and determine cost optimization. Utilization rates were compared with the number of excess long-stay CR patients (ie, patients who spent more than 30 minutes waiting in the radiology department prior to CR examination) and with the cost (per excess long-stay CR patient who waited more than 60 minutes) averted by using DR. RESULTS: Excess annual costs for DR over CR at the four sites ranged from $50,757 to $75,303. At extrapolated levels of economic penalties for long waiting times, the crossover point at which the DR cost became justifiable was when CR capacity utilization rates approached or exceeded 80%. CONCLUSION: In the current practice environment, with capacity utilization rates well below 80%, CR is likely to be a more cost-effective technology for the majority of general radiography providers.

Costs and Cost Analysis↗

PubMed1991

Are there interactions and relations between genetic and environmental factors predisposing to high blood pressure?

An overview of published observations suggests that both genetic predisposition and environment work together to produce hypertension in most persons. High blood pressure before age 55 occurs 3.8 times more often among persons with a strong positive family history of high blood pressure. Much of the total variability in blood pressure in modern populations seems attributable to genetic factors. Estimates of the proportion of the variance attributable to all genetic factors (heritability [H2]) vary from 25% in pedigree studies to 65% in twin studies for sitting diastolic blood pressure. Several biochemical traits associated with high blood pressure are highly genetic (H2, 78-84%) and may help elucidate the pathophysiology of high blood pressure. While pertinent environmental factors such as salt intake, alcohol use, and amount of exercise also correlate significantly among relatives, only 7% of the total variance of diastolic blood pressure seems attributable to all shared environmental factors in family households. Thus most familial aggregation of high blood pressure appears to be due to genes rather than shared family environment. Practical benefit may result from identifying familial predisposition in multiple siblings with high blood pressure before age 55 and lipid abnormalities (labeled "familial dyslipidemic hypertension"). About 12% of high blood pressure patients have familial dyslipidemic hypertension and also have high risk of early coronary heart disease. Hyperinsulinemia and central obesity as well as high triglycerides and low high density lipoprotein cholesterol are prominent features of familial dyslipidemic hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗

PubMed1996

Studying multidimensional constructs through cluster analysis.

The analysis of multidimensional constructs presents a challenge. The challenge is to combine the information from the dimensions relating to the construct in a meaningful way. This article examines a complex construct known as the nursing practice environment and describes the use of cluster analysis to combine information from three dimensional measurements to operationalize the construct.

Cluster Analysis↗

PubMed1994

Quality improvement and public health--tetanus immunization in the emergency department.

The administration of tetanus toxoid vaccine to both adults and children represents an often neglected, but medically necessary procedure for patients who receive traumatic injuries to nature's natural surface barrier, the skin. While performing retrospective chart reviews, the collaborative practice environment fostered in the Emergency Department at Reston Hospital Center, (wherein the physician and nursing staff are schooled in Deming's Quality Improvement-FOCUS-PDCA-methodology, and the concepts of "patient care clinical process ownership," and "professional job enlargement and job enrichment" diffuse throughout the Emergency Services Systems design), identified a potential problem with tetanus immunization related to existing standing orders. Initial data collection utilized count-between methodology. Over a 31-day period, 216 patients who required tetanus immunization were identified. Appropriate tetanus toxoid administration was "missed" 20 times, with a median of 9 appropriate tetanus immunizations before an administration was "missed." Flow chart analysis of the tetanus toxioid administration process identified the sources of variation of that process. A pilot PDCA cycle was instituted to redefine the process, control the variability, and measure the results. Upon completion of the third PDCA cycle of 31 days, 367 patients were identified who required tetanus immunization. Appropriate tetanus toxoid administration was "missed" 3 times with a median of 120 appropriate tetanus immunizations before an administration was "missed." Conclusions include: a) The appearance of special cause variation, (diaster situations), must be recognized as having the potential to disrupt healthcare process improvements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Cases of conscience: casuistic analysis of ethical dilemmas in expanded role settings.

In the absence of a well articulated conceptual framework for nursing ethics, this article argues for a theory of applied ethics--casuistics--used within a clinical reasoning model, to analyse the complicated issues presented in three cases involving adolescents receiving treatment for abuse through a rural alternative learning centre. The clinical nurse specialist, as an independent practitioner within the community, is presented with many ethical challenges arising from cultural diversity. The inherent independent nature of such practice environments combined with the pluralism which exists in today's multicultural society demands that professional nurses working in these circumstances develop and utilize an ethical framework for the analysis of patient care in situations that involve moral conflict.

Adolescent↗

PubMed2006

The global nursing shortage: an overview of issues and actions.

Today's global nursing shortage is having an adverse impact on health systems around the world. A major initiative by the International Council of Nurses (ICN) yielded important information regarding the shortage and solutions to it. These are organized into five priority areas: policy intervention; macroeconomics and health sector funding; workforce planning and policy, including regulation; positive practice environments; and retention and recruitment (includes migration); and nursing leadership. Internationally momentum is building, providing the opportunity to bring attention to these issues and to take action. This article presents an overview of the global nursing shortage (which, since 2002, has been termed a global crisis), provides the perspectives of the ICN, and discusses the ICN's initiatives regarding that crisis. Founded in 1899, the ICN is the world's first and largest organization for health professionals. As a federation of national nurses' associations in 129 countries, ICN represents the more than 13 million nurses working worldwide. It works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected, competent professional workforce.

Internationality↗