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PubMed1991

Perioperative nursing: moral and ethical issues in high--technology practice.

The caring component of perioperative nursing practice entails responsibility and accountability for nurses to identify and address the moral/ethical issues inherent in the practice. Ethical/moral issues in perioperative nursing are becoming more complex as technology becomes more sophisticated, financial resources become more restricted, and choices regarding care occur in an ambiguous environment. The practice environment must provide processes by which nurses can examine the ethical/moral choices made or to be made both to support the nurse and to increase the body of knowledge of perioperative nursing practice.

Ethics, Nursing↗
PubMed1993

Environments that support ethical nursing practice.

Creating an ethical work environment in a health care organization is both necessary and difficult. In the process of providing care, nurses often make decisions with ethical implications. This decision making is enhanced when the work environment supports an ethical approach. Nursing can implement strategies to support ethical decision making.

Decision Making↗
PubMed2005

Obstacle avoidance in novel visual environments improved by variable practice training.

Motor performance on simple tasks improves after training in variable practice. We asked if locomotor skill during an obstacle-avoidance task in a novel sensorimotor environment improved through training in variable practice on other complex tasks. 40 normal adults practiced gross motor skills while wearing either sham lenses, one of several visual distortion lens (constant practice), or three different visual distortion lenses (variable practice). Posttests on obstacle avoidance with novel lenses showed significantly better scores with variable practice and one of the constant groups vs sham lenses. Constant and variable practice groups did not differ. Thus, performance in a novel environment improves after training on similar type novelty, even when practice and test conditions differ. Constant practice was effective only if the subjects used the lens efficacious in training. Variable practice increases the likelihood of efficacious training when adaptive performance is required in a novel environment.

Adult↗
PubMed2003

Care of the critically ill patient in a military unique environment: a program of research.

The goal of the Air Force Nursing Research Program at WHMC is to conduct research on topics unique to Air Force and military nursing. The nine stressors of flight and the military environment of care have been used as a conceptual model to guide the development of research studies. The studies conducted to date describe how the environment affects practice and when the environment directly affects the patient. The studies conducted are examples of the numerous military nursing research projects supported by funding from the TSNRP. The research funded by TSNRP contributes to the body of nursing knowledge by supporting scientific research, particularly knowledge that is unique to the military. As our nation faces the threat of chemical and biologic attacks, terrorism, and increased deployment of soldiers to battlefields in remote locations throughout the world, it is more important than ever that we ensure the advancement of military nursing research. Supporting research that advances healthcare in peace and in war is critical to the care of our military members and their families. This will require that research funds continue to be available to support military nursing research, that a strong infrastructure to provide resources in support of nursing research programs continues to exist, and that the military nursing corps continues to attract, train, and retain PhD prepared nurse researchers. Given the results of the research completed to date, the following evidence-based practice can be applied to the care of the patient described at the beginning of this article: The nurse positions the patient in the center of the cargo compartment, away from the bulkhead, toward the front of the aircraft, the warmest location during flight. While enroute, the patient will need to be positioned on an aerovac mattress, repositioned frequently, and have his/her heels elevated at all times. Additional padding may be needed for areas adjacent to the litter cross members to reduce pressure on the skin in areas prone to pressure ulcer formation. Should the patient need endotracheal suctioning, the nurse knows that hyperoxygenation-hyperinflation is effective in preventing suctioning-induced hypoxemia. In addition, the suction pressure will need to be increased to account for the effects of altitude without exceeding the pressure limits on the transport ventilator and causing catastrophic ventilator failure. Because there is not enough room on the litter for the chest tube drainage tubing to lay straight, it will be coiled and should dependent loops develop, they should be drained every 15 minutes. This is Air Force nursing research in practice.

Aerospace Medicine↗
PubMed1997

Environments that support ethical practice.

Our healthcare system is fundamentally flawed in the ability to provide quality end-of-life care. The provision of quality end-of-life care involves a complex interaction of personal, professional, and societal values and practices. Attention to each dimension of end-of-life care is essential to improve the care of the dying patient and his/her family. Given the complexity of this problem, this article focuses on the critical care environment and the aspect of organizational culture and specific strategies for improvement. Several inter-related components of an environment which may foster ethical thinking, decision-making, and behaviors are discussed including organizational culture, individual agency, collaboration, and educational resources. Every member of the healthcare team has the responsibility to be a catalyst for creating a critical care environment where ethical practice is expected and rewarded rather than punished and suppressed. As a healthcare team, our ultimate goal is to provide healing and humane end-of-life care for all patients and families.

Cooperative Behavior↗
PubMed1987

The practice of pediatric surgery in a medical school environment: is there a conflict between private practice and academic pursuits?

An 11-year review of the clinical practice and the academic activity of the Section of Pediatric Surgery at the University of Michigan was carried out. This was done in an attempt to determine whether or not increased clinical practice in a medical school environment would have a detrimental effect on academic productivity. Clinical activity was evaluated by analyzing the number of patients seen, the number of operations, patient days, admissions, and revenue generated. Academic activity was analyzed by measuring the number of hours of formal lectures and conferences, research space and personnel, the number of completed and active projects, grant support, and the number of publications. During this 11-year period, the number of operations performed increased from 525 per year to over 1,350, the number of office visits increased from 11 per week to 60 to 65, and the gross revenue increased six-fold. At the same time, the number of formal lectures and conferences given increased from 50 to 267 hours per year, the research space increased from 200 to 1,612 square feet, the research budget increased from $20,000 to $120,000 per year, grant support increased from 0 to $62,000 per year, and the number of publications increased from five to 17 per full-time equivalent (FTE) per year. In fact, this review indicates that during the time that clinical practice and revenue generation increased, so did academic productivity in the form of manuscript writing, project completion, and grant acquisition.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed2003

Negotiating for change. The healthcare manager as catalyst for evidence-based practice: changing the healthcare environment and sharing experience.

This paper addresses the problem of the implementation of both clinical and managerial evidence-based decision-making in healthcare. The lack of implementation of research findings in clinical and management practice has been identified as a key failure in healthcare. Many await the development of better methods of research transfer led by academics and clinicians. Research transfer has become one of the highest priority are as for health services research. In this paper, the authors propose that the healthcare manager is well positioned to advance the research transfer process within the individual healthcare environment through two main mechanisms. First, healthcare managers can align decision-making structures within their own environment to facilitate evidence-based practice. This can occur by managers demonstrating a commitment to processes for the measurement and management of knowledge (identifying knowledge stewards) to the same extent that they demonstrate commitment to the measurement and management of finances. Within such a framework, the healthcare manager can build an environment in which there is an explicit "negotiation" between "knowledge stewards" (usually clinicians) and "financial stewards" (usually administrators) to achieve a common goal. The negotiation is an explicit, documented process that addresses the trade-offs that are made to avoid both financial and quality deficits in the organization (the quality deficit is defined as the gap between knowledge and practice). The second way in which healthcare managers can act as catalysts for promoting evidence-based practice is through cataloguing and reporting, using documented stories, the unique barriers to evidence-based approaches that are peculiar to their specific healthcare environments. It is hypothesized that local contextual circumstances, which can be expressed only through stories, are the most powerful barriers to research transfer within specific organizations. This has implications for what we count as useful knowledge as we try to better understand how rigorous research on the one hand and research and stories on the other contribute to strategies for research transfer at the organizational level.

Decision Making, Organizational↗
PubMed1994

Pica in an urban environment.

The practice of pica, the compulsive ingestion of nonfood substances over a sustained period of time, was studied in 553 African American women who were admitted to prenatal clinics in Washington, D.C. Dietary, biochemical, and psychosocial correlates of the pica practices of a subset of this urban population are presented in this paper. Geophagia, compulsive eating of clay or dirt, was not observed in these women; pagophagia, or the ingestion of large quantities of ice and freezer frost, was self reported in 8.1% of the women, who consumed 1/2 to 2 cups a day from 1 to 7 days per week. Serum ferritin concentrations of pica women were significantly lower during the second and third trimesters of pregnancy; the average values for three trimesters of pregnancy for both ferritin and mean corpuscular hemoglobin were significantly lower in pica women than their nonpica counterparts (P = 0.0001 and P = 0.017, respectively). Although not significantly different, the iron (66 vs. 84% RDA) and calcium (60 vs. 75% RDA) contents of the diets of pica women were less those of nonpica women. Gestational age, body length, and body weight were not different, but head circumferences of infants delivered to pica women who consumed freezer frost and/or ice were smaller than those of nonpica women (P = 0.012). The hypothesis is presented that pica in African American women may be a mediator of stress, acting through the immune system. The size of the social support network of pica women was significantly less than that of nonpica women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

Patient participation in a medical education environment.

Family practice residency programs are specifically directed toward training primary care physicians to serve the interests of communities. This paper describes two methods of developing a feedback mechanism to increase the awareness of physicians in training to patients' health needs and desires. One method involves the development of a patient advisory group in the Family Practice Center at The University of North Carolina, and the other an ongoing telephone survey of patients who call after hours.

Family Practice↗
PubMed1997

Managing the challenges of role diversification in an interdisciplinary environment.

Advanced practice nurses are increasing in number. Such nurses include the nurse practitioner, clinical nurse specialist, nurse anesthetist, and nurse midwife. The roles of nurse practitioners and clinical nurse specialists have been recommended by the American Nurses Association to merge. The frustrations related to this merger are identified, and strategies are proposed to resolve them. Examples of military, civilian, and international models are provided.

Australia↗
PubMed2005

Monitoring and predicting cognitive state and performance via physiological correlates of neuronal signals.

Judgment, decision making, and situational awareness are higher-order mental abilities critically important to operational cognitive performance. Higher-order mental abilities rely on intact functioning of multiple brain regions, including the prefrontal, thalamus, and parietal areas. Real-time monitoring of individuals for cognitive performance capacity via an approach based on sampling multiple neurophysiologic signals and integrating those signals with performance prediction models potentially provides a method of supporting warfighters' and commanders' decision making and other operationally relevant mental processes and is consistent with the goals of augmented cognition. Cognitive neurophysiological assessments that directly measure brain function and subsequent cognition include positron emission tomography, functional magnetic resonance imaging, mass spectroscopy, near-infrared spectroscopy, magnetoencephalography, and electroencephalography (EEG); however, most direct measures are not practical to use in operational environments. More practical, albeit indirect measures that are generated by, but removed from the actual neural sources, are movement activity, oculometrics, heart rate, and voice stress signals. The goal of the papers in this section is to describe advances in selected direct and indirect cognitive neurophysiologic monitoring techniques as applied for the ultimate purpose of preventing operational performance failures. These papers present data acquired in a wide variety of environments, including laboratory, simulator, and clinical arenas. The papers discuss cognitive neurophysiologic measures such as digital signal processing wrist-mounted actigraphy; oculometrics including blinks, saccadic eye movements, pupillary movements, the pupil light reflex; and high-frequency EEG. These neurophysiological indices are related to cognitive performance as measured through standard test batteries and simulators with conditions including sleep loss, time on task, and aviation flight-induced fatigue.

Aerospace Medicine↗
PubMed1999

The financial environment of aesthetic surgery: results of a survey of plastic surgeons.

To gather information about aesthetic surgery's current practice structures, competitive environment, patient price sensitivity, and marketing and practice development requirements, a two-page survey was developed and mailed to all 1180 members of the American Society for Aesthetic Plastic Surgery. A total of 632 surveys were returned (response rate of 54.5 percent). Most aesthetic plastic surgeons said they were in solo practice (63.3 percent). More than two-thirds described the marketplace as "very competitive," with 59 percent reporting 25 or more surgeons offering aesthetic surgery in their area. They estimated their patients' average income at $62,800. Nearly all plastic surgeons labeled their patients as "moderately price sensitive" (62.3 percent) or "very price sensitive" (30.6 percent). Similarly, 23.2 percent estimated that they had lost 20 or more patients within the last year for reasons of price. Practice development and marketing efforts represented an average of 7.3 percent of plastic surgeons' working time. Parameters associated with a high percentage of time devoted to these activities were solo practice, percentage of revenue from aesthetic surgery greater than 50 percent, a practice environment designation of moderately or very competitive, and ten or more area surgeons offering aesthetic surgery (p < 0.05). High patient income led to only slight decreases in price sensitivity and did not significantly reduce the amount of time spent on marketing and practice development. Although the rest of the healthcare industry has undergone a period of consolidation, aesthetic surgeons have been able to resist these changes. The results of this survey suggest that the fragmented nature of the aesthetic surgery industry is associated with additional burdens on plastic surgeons. As the aesthetic surgery market becomes more competitive, plastic surgeons may benefit from consolidation to reduce costs and maximize efficiency.

Fees and Charges↗
PubMed1997

Practice-based research: importance, challenges and prospects. A personal view.

Observation from the 'real-world' environment of dental practice is increasingly recognised to be of importance in the interpretation of research data from academia and dental health services research. In fact, most forms of applied dental research may be undertaken in the dental practice environment. However, in order to contribute to existing knowledge and understanding, practice-based research must be both rigorous and meticulous in its design, and subjected to scrutiny through presentation and publication before being considered to have been successfully concluded.

Clinical Trials as Topic↗
PubMed2004

Junior doctors' opinions about the transition from medical school to clinical practice: a change of environment.

INTRODUCTION: Concerns have been growing about the effects of the working environment on junior doctors and the learning opportunities available to them. In order to identify problems and opportunities for improvement, we explored junior doctors' opinions about the transition from student to practitioner. METHOD: Seventeen recent graduates in four focus groups discussed the transition. DATA ANALYSIS: Related comments were combined in the report of the discussions, which was approved by the participants. RESULTS: The transition was perceived as a major change, particularly the increased responsibility and workload and contacts with other health care workers and patients. Preparation during undergraduate training was adequate as regards knowledge, communication, history taking and physical examination skills but not for pharmacological knowledge and patient management skills. Problems were connected with practical procedures and feelings of uncertainty. There was little formal education. Proposals to ease the transition were earlier patient contacts, more involvement in patient management and growing responsibility during clerkships. DISCUSSION: Although the sample was small, the uniform opinion in all groups supports the validity of the findings. Junior doctors felt confident with regard to knowledge and skills, but experienced difficulties with patient management, practical matters and their role on the team. Contrary to the idea of an educational continuum, formal learning appeared to be very limited in the hospital environment. CONCLUSIONS: Preparation for medical practice may benefit from active involvement of clerks in patient management decisions and a gradual increase in responsibilities. An effective medical education continuum would require more attention for house officers' learning.

Attitude of Health Personnel↗