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PubMed1997

Advising nursing students in a tightened job market.

Although new graduates face a more restricted job market, we continue to need new registered nurses to replenish and renew the profession. As employment settings shift from hospital to community settings and optimal and cost-efficient skill mixes are determined, faculty will need to work closely with students, administrators, and nurse recruiters to assist new graduates to face the challenges evolving in today's practice environments.

Economics, Nursing↗

PubMed2005

Being a supportive presence in online courses: attending to students' online presence with each other.

As a teacher involved in distance education, being a supportive presence includes attending to and facilitating students' knowing and connecting with other. This creates places for learning that are safe, fair, and respectful, which reflects the concerns of the interpretive pedagogies (Diekelmann & Diekelmann, in press). Reflecting a larger issue is the importance of contemporary nurses' knowing and connecting with other team members, and with patients, online in ways that engender community and achieve desired outcomes. With this in mind, attending to the Concernful Practices that enable students to know and connect in ways other than face-to-face encounters becomes even more relevant in preparing for today's practice environments.

Attitude of Health Personnel↗

PubMedDate not supplied

Diagnostic evaluation of the patient with coronary artery disease.

BACKGROUND: Evaluation of patients with possible coronary artery disease is a challenge to clinicians who face conflicting pressures in the current practice environment. Sensitivity, accuracy, cost, and access have become considerations in the appropriate selection of diagnostic studies. OBJECTIVE: To review and compare the strengths and shortcomings of commonly employed noninvasive techniques for diagnosing coronary artery disease. DISCUSSION: The patient's history is still key in establishing a diagnosis. Exercise electrocardiography (ECG) is not as sensitive or specific as exercise echocardiography or radionuclide studies, but it is relatively inexpensive and accessible. Further, new criteria for interpreting the results of exercise ECG may improve its diagnostic accuracy. The predictive value of any test increases in populations where the prevalence of disease is higher, as in patients with known risk factors for coronary artery disease. Patients who cannot exercise or who have concomitant conditions that obscure the results of exercise ECG are candidates for other diagnostic techniques. CONCLUSION: Rational diagnostic plans for evaluating patients who may have coronary disease can be developed on the basis of existing information and reported experience.

Coronary Disease↗

PubMed2005

[Perception about problem-based learning in reflective journals among undergraduate nursing students].

OBJECTIVE: The aim of this study is to explore the variation in perceptions about problem-based learning(PBL) according to the level of academic achievement and learning attitude in the nursing students of a junior college (3-year program). METHOD: Students (n=39) learned the respiratory and cardiac system with seven PBL packages and group-based learning for a semester in 2002. Students were asked to write reflective journals that focused on their learning perception after an experience with each learning package. A total of 208 journals were used for analysis. RESULT: Students positively perceived that PBL making them increase their sense of responsibility for learning and felt satisfaction with the learning process, and had a confidence in the use of clinical nursing interventions. On the other hand, they negatively perceived that PBL was a burden because it took more time than traditional learning tasks, and they experienced an anxiety about regular tests and felt conflicts and diffidences in the learning process. The negative perceptions were expressed more often from students with a low academic achievement and low learning attitude compared to others. CONCLUSION: Students perceived the PBL as effective in understanding the learning concepts in the clinical practice environment. PBL need to be supplemented by feedback-based lecture and facilitative strategies for academically low-achieved students.

Adult↗

PubMed1984

Changes in serum lipid levels during antihypertensive therapy.

The antihypertensive action of prazosin and propranolol, as well their effect on serum lipid levels, were evaluated in a crossover study in 20 men with untreated mild to moderate hypertension in a general practice environment. Both prazosin (7.5 +/- 0.5 mg/day) and propranolol (270 +/- 26 mg/day) produced a similar reduction in blood pressure over an eight-week period. The administration of propranolol also led to a reduction of the mean fasting high-density lipoprotein cholesterol concentration by 10.5% (P less than 0.01) and this effect was dose-related (r = -0.414; P less than 0.05). Prazosin treatment produced no changes either in the total or in the high-density lipoprotein cholesterol levels, but led to a reduction of the total triglyceride levels by 9.5% (P less than 0.05). These results suggest that the value of blood pressure reduction produced by high doses of beta-adrenoceptor blocking agents, such as propranolol, may be diminished by a potentially adverse effect of these agents on serum lipid levels. Conversely, alpha-adrenoceptor blocking agents may confer an added benefit in the treatment of hypertension.

Adult↗

PubMed1992

Teaching preventive medicine and health maintenance.

Preventive health care is an important part of the practice of internal medicine but is poorly taught and practiced in most residencies. A successful curriculum would impart knowledge of the preventive health care guidelines recommended by expert groups; provide opportunities for residents to understand the conceptual basis of preventive care; expose residents to clinical faculty with positive attitudes toward prevention; help residents to learn skills in physical examination, screening tests, and counseling in behavioral modification relevant to prevention; and provide a practice environment in which high-quality preventive health care is possible. All of the skills can be learned as other aspects of medicine are now learned--under the guidance of capable and respected faculty teaching at the bedside, in the clinics, and during ward rounds and conferences.

Attitude of Health Personnel↗

PubMed2003

Using information technology to improve the health care of older adults.

The high burden of illness and frailty common among our growing population of older adults often results in fragmentation of care across providers and health care systems, increasing the complexity and costs of caring for these patients. Information technology offers one way to meet this challenge. Scientists at the Regenstrief Institute have more than a quarter-century of experience in using medical informatics to support clinicians in the day-to-day care of older adults. Their research has progressed through several evolutionary cycles, beginning with the acquisition of relevant data and moving to studies of the most efficient and effective mechanisms that bring information to bear at the time of clinical decision making. Information technology designed with the input of the end user has the greatest promise of changing provider behavior because it balances technological challenges with the cultural context of the practice environment. One topic of active research is information technology to support transitions of care among sites and providers. These transitions place older adults at increased risk for avoidable illness, death, and health care costs. Information systems that improve communication among providers during these transitions have the potential to improve safety and reduce costs.

Aged↗

PubMedDate not supplied

Using workshops to implement supervision.

Clinical supervision is both topical and novel among many practice disciplines so it is important to consider how to take such an important initiative forward. This article describes a series of workshops designed to achieve this aim. The article focuses on the participants' perceptions of clinical supervision and its relevance to their practice environment. The authors also suggest ways to assist clinical staff further in this area.

Clinical Competence↗

PubMed1991

Medical staff membership criteria: a credentialing minefield.

In today's increasingly competitive medical practice environment, legal challenges to credentialing decisions abound. To minimize the risk of liability, hospitals and their medical staffs must be especially careful when adopting and applying the criteria for medical staff membership.

Clinical Competence↗

PubMed1991

Drug-usage evaluation in the community hospital.

All hospital pharmacists can contribute to their medical staff's responsibility in completing effective DUR. The means available and practice environment for each setting will dictate specific methods to successfully complete DUR. It is not always necessary to have the most advanced systems or automated technology to make an impact on a DUR program. Often a simple, common sense approach to DUR can produce surprisingly effective results.

Drug Utilization↗

PubMed1996

Integrating chiropractic in managed care.

Alternatives to traditional health care are emerging as an important element in the mix of services offered by managed care plans. Integrating these nontraditional services, such as chiropractic, presents special challenges for plan managers. ChiroNet, an Oregon-based chiropractic specialty PPO network, has formed partnerships with a variety of managed care plans bringing managed chiropractic services to the PPO, EPO, and HMO environments. Practical experience with benefit design, access protocols, utilization management, quality assurance, provider credentialing, and administrative integration has been developed over the period of the network's cooperation with its managed care partners. Successful integration of these nontraditional provider groups depends on alignment of goals and incentives among all players in the system, including providers, their network, the patients, and the managed care plan.

Back Pain↗

PubMed1986

Practitioners' assessment of the externship experience: a retrospective analysis. Part I.

This study examines the externship experience of participants in the first four years of Illinois' mandatory externship program. A questionnaire was developed and mailed to a sample of 300 pharmacists resulting in a 60 percent response rate. Analysis of the data suggest a generally positive attitude toward externship and this was especially true for more recent graduates. It was also found that preceptors were perceived as positive role models, that externship had only slightly positive impact on preparing the respondents for practice and their perceived development of self confidence, and had virtually no influence on their ultimate choice of practice environment. These findings hold important implications for future refinements of externship programs.

Attitude of Health Personnel↗

PubMed1986

Medicare capitation and quality of care for the frail elderly.

Previous studies have shown that the quality of care provided in health maintenance organizations (HMO's) is either similar or better than that in fee-for-service settings; however, few studies have included sufficiently large numbers of older persons. Although it is reasonable to believe that healthy older patients will do as well in HMO's as younger people, the outcome for the frail elderly is less certain. This population may not do as well in the conservative medical practice environment of HMO's, and decreased hospitalization may have detrimental effects on their health. On the other hand, this population may benefit from the improved continuity of care and potential for comprehensive assessment in HMO's. The quality of care received by the frail elderly will be an important test of the success of Medicare capitation.

Aged↗

PubMedDate not supplied

The treatment center: a model for competitive clinical practice.

The treatment center model described in this article was developed with the intent of providing a high technology practice environment that would attract patients to an academic center for their medical care. It was also intended to create an environment that would result in the retention of the best clinicians within the academic framework. Appropriate goals and incentives had to be determined by both the hospital and the professional groups involved. Many preconceived ideas regarding traditional academic structures needed to be revised to implement this program.

Academic Medical Centers↗

PubMed2000

Enabling, empowering, inspiring: research and mentorship through the years.

The interrelationship between research and mentorship in an association such as the Medical Library Association (MLA) is revealed through the contributions of individuals and significant association activities in support of research. Research is vital to the well-being and ultimate survival of health sciences librarianship and is not an ivory tower academic activity. Mentorship plays a critical role in setting a standard and model for those individuals who want to be involved in research and, ultimately, for the preparation of the next generation of health sciences librarians. Research and mentorship are discussed in the context of personal experiences, scholarship, and problem solving in a practice environment. Through research and mentorship, we are enabled to enhance our services and programs, empowered to look beyond our own operations for information puzzles to be solved, and inspired to serve society by improving health.

Fellowships and Scholarships↗

PubMed1999

The day the lights went out: one charge nurse's nightmare.

The synergy model can be applied to many clinical situations. As nursing leaders evolve, competencies required to effectively respond to unexpected events silently develop. Applying the Synergy Model to this exemplar helped to articulate the charge nursing's leadership in ensuring a safe practice environment. The model provides a framework to more fully describe the multiple dimensions of a charge nurse's role, and acknowledges the richness of knowledge and competence that charge nurses often contribute to complex clinical situations.

Adaptation, Psychological↗

PubMed1999

New paradigms for medical decision support and education: the Stanford Health Information Network for Education.

The information needs of physicians are complex and ever increasing in a world of rapidly expanding medical knowledge and a practice environment where physicians are required to know and do more with shrinking resources. Current strategies for providing clinical decision support and continuing medical education have failed, in part, because they have not provided timely, easy access to information that is current, integrated with other information and the physician's workflow, and relevant to specific questions that occur during the patient encounter. Meeting these challenges involves understanding the nature of medical knowledge, the different information needs of physicians, the clinical decision-making process, and the constraints of the physicians work environment, as well as the traditional barriers to physician education. We explore the nature of some of these challenges and propose one solution in the form of a highly integrated web-based technology--The Stanford Health Information Network for Education.

Academic Medical Centers↗

PubMed1999

Nurse staffing and patient outcomes: evolution of an international study.

Industry-wide health sector reforms in the United States, Canada, and Europe have provided a unique opportunity to examine the effects of hospital restructuring on inpatient nursing care and patient outcomes across an array of settings. Seven interdisciplinary research teams--1 each in Alberta, British Columbia, England, Germany, Ontario, Scotland, and the United States--have formed an international consortium whose aim is to study the effects of such restructuring. Each site has enrolled large numbers of hospitals and nurses to explicate the role that organization of nursing care, a target of hospital restructuring, plays in differential patient outcomes. The study seeks to understand more fully the influence of both nurse staffing and the nursing practice environment on patient outcomes. Discussion of the theoretical foundation, study design, and process of developing the study instruments and measures illustrates the process to date, as well as the feasibility of and opportunities inherent in such an international endeavour.

Alberta↗