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At least 685 records · Page 38Linked to original sources
PubMed1998

The organizational structure of medical group practices in a managed care environment.

This article analyzes the organizational structures of 155 medical group practices providing services in the highly competitive managed care environment in the upper midwest. The structure of the group practices and the methods of physicians' payment are analyzed in terms of the proportion of revenue obtained from financial risk-sharing managed care payment systems and the length of time involved with those systems.

Blue Cross Blue Shield Insurance Plans↗
PubMed2003

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

This thoughtful essay conveys a logically ordered series of concepts that may help develop a process to more fully integrate evidence into healthcare management decisions. In responding to this article we have tried to think broadly about what might be discovered if the ideas of Browman, Snider and Ellis were put into practice. We have chosen to focus on factors that could confound the five-point plan suggested by the authors. Browman, Snider and Ellis provide an interesting overview and advocacy for evidence-based medicine and its application. The authors recognize that the area under investigation, oncology, may lend itself more readily than others to the facilitation of evidence-based practice. They introduce the concept of healthcare as a negotiating environment and the healthcare manager as a potential catalyst for change. In their conclusions the authors offer healthcare managers a five-point plan: 1. Express the value that knowledge is a core resource. 2. Structure decision-making to involve the stewards of knowledge and stimulate negotiation while encouraging the parties to express shared goals. 3. Invest in strategies that support knowledge management, including arbitration. 4. Demonstrate leadership and develop organizational metaphors to encourage participation. 5. Share the results and experiences of evidence-based decision-making.

Decision Making, Organizational↗
PubMed1997

The impact of the classroom environment on defining function in school-based practice.

OBJECTIVE: Whether the environment is stressed in function-dysfunction decisions appears to depend on where in the hierarchy of components of complex tasks and of role skills the evaluating therapist is focused. This study examined the intervention planning decisions of occupational therapists who used the Model of Student Role Adaptation, which emphasizes the complex tasks involved in the student role. The purpose of the study was to determine whether these therapists were responding to environmental demands in planning their interventions. METHOD: Special education teachers selected tasks that they believed were the most essential for student functioning within their classroom environments. These selections were compared with the goals and objectives developed by occupational therapists who serve children in these settings. RESULTS: Chi square analysis indicated a significant relationship between tasks designated by the teacher participants as environmental demands and those included in occupational therapy intervention planning. CONCLUSION: The results suggest that the occupational therapist participants were responding to the environmental demands of the classroom when constructing their intervention plans.

Activities of Daily Living↗
PubMedDate not supplied

Compliance with primary prevention in private practice: creating a tobacco-free environment.

A sample of private orthodontic practices (n = 40) from a controlled trial for clinician-initiated tobacco-use prevention was used to test the effectiveness of preventive medicine representative (PMR) visits in creating and maintaining an anti-tobacco office environment. Clinical staff of 20 offices, randomly assigned to the experimental group, were trained by a PMR on the use of anti-tobacco materials (no-smoking signs, posters, and print materials). Twenty control-group offices did not receive any training or special treatment. Subsequently, experimental-group offices were visited by a PMR once every three months and were telephoned six weeks after each visit over a 12-month period. During visits and phone calls, PMRs prompted offices to order anti-tobacco materials. Visits served to introduce offices to new materials and to encourage their continued use. Data from direct observations and self-report measures showed significant differences between experimental and control offices for display of anti-tobacco materials at 1.5 months and 12 months (P < .001). Results suggest that PMR visits may serve as an effective method of introducing and maintaining preventive medicine procedures in clinical environments.

Community Participation↗
PubMedDate not supplied

Perspectives on neonatal nursing: 1985-2005.

Neonatal nursing practice has been influenced by a number of external forces over the past 20 years. This article explores some of the influences that have altered practice in the 20-year history of the Journal of Perinatal & Neonatal Nursing. Attention is directed to several significant influences such as the development of the Internet and the World Wide Web and the role that information plays in care delivery. Changing practice roles with the continuing evolution of the neonatal nurse practitioner role and the emerging plans for the doctorate of nursing practice are described. The history of professional associations for neonatal nurses and the impact of evidence-based practice are considered. Finally, the legal environment surrounding practice is explored.

Education, Nursing, Continuing↗
PubMed1986

Clinical ecology--a critical appraisal.

In 1981 the California Medical Association (CMA) adopted the position that clinical ecology does not constitute a valid medical discipline and that scientific and clinical evidence to support the diagnosis of "environmental illness" and "cerebral allergy" or the concept of massive environmental allergy is lacking. As a result of requests from clinical ecologists for an opportunity to present to CMA evidence justifying their diagnostic and treatment methods, the chair of the CMA Scientific Board, Allen W. Mathies, Jr, MD, appointed a task force in 1984 to review clinical ecology. The task force conducted an extensive literature review and held a hearing. CLINICAL ECOLOGY IS BASED ON TWO MAIN HYPOTHESES: first, that the total load of low-dose environmental stressors is important in the induction of illness; and, second, that changes in the frequency of and intervals between exposures to specific substances can mask the clinical manifestations of or alter the degree of sensitivity to those substances. Treatment methods used by clinical ecologists include avoidance, symptom-neutralizing doses of diluted extract of the offending agents, rotation diets and an ecologically sound workplace and home.The task force recognizes that certain environmental chemicals and allergens produce well-defined syndromes in humans and that some patients suffer from illnesses that are not readily diagnosed and for which only supportive therapy exists. The conclusions of the task force are* There is no convincing evidence that supports the hypotheses on which clinical ecology is based.* Clinical ecologists have not identified specific, recognizable diseases caused by exposure to low level-environmental stressors.* Methods to diagnose and treat such undefined conditions have not been shown to be effective.* The practice of clinical ecology can be considered experimental only when its practitioners adhere to scientifically sound research protocols and inform their patients about the experimental nature of their practice.

Environment↗
PubMed1991

Nursing group practices in hospital settings.

As hospitals continue to face problems with nursing shortages and difficulty in retaining experienced nurses, they are forced to examine the environment of nursing practice to determine how that environment can be improved. At Henry Ford Hospital, a planning process is underway to establish a more truly professional practice environment for nursing. This professional practice environment is based on a group practice model for inpatient nursing. The group practice model offers the potential for greater clinical and administrative autonomy and collaborative practice with physicians, but may require significant changes in internal budgeting and accounting systems. Several different inpatient group practice models and their implications are discussed.

Group Practice↗
PubMedDate not supplied

Patient retention: the practice management challenge under managed care.

The increasingly competitive environment of practice management has become more complicated with the growing penetration of managed care and capitation. Although successful growing practices have always focused on attracting new patients into the office, future efforts must also be directed at retaining the current patient. Additionally, capitation will require that a practice redefine the profile of a patient valuable to the practice. This article provides a perspective on the valuable patient in a capitated setting as well as some strategies to build better relationships with patients to retain their loyalty. Finally, this article proposes a system to monitor the ongoing satisfaction of patients to retain loyalty.

Humans↗
PubMedDate not supplied

Building quality practice settings: an attributes model.

To practice effectively nurses need an environment that supports quality professional practice. This article describes the development of a model identifying seven (7) key system attributes of a quality practice setting. The defined attributes are essential in supporting professional practice and quality care. The Quality Practice Setting Attributes Model developed by the College of Nurses of Ontario in Canada provides the foundational framework for the Practice Setting Consultation Program (PSCP), a unique quality improvement approach to creating quality practice environments.

Focus Groups↗
PubMed1994

Advanced practice roles in the managed care environment.

The role of the advanced practice nurse is based on expert clinical knowledge and skill and is practiced in multiple settings. As healthcare reform emerges, the context in which healthcare is delivered changes. The authors describe a creative approach to packaging and marketing the services of advanced practice nurses to the customers of the managed care system.

Humans↗
PubMed1980

The "least restrictive environment": from rhetoric to practice.

During the past 10 years, more and more general hospitals have opened psychiatric units, many of which represent the best of modern hospital psychiatry. Therapeutic success on these units is based on control of admissions as well as on clinical programs. Pressure from the State to admit involuntary patients, recently justified by the doctrine of the "least restrictive environment," threatens to erode the quality of treatment now being provided. The concept of "least restrictive environment" is ambiguous and sometimes misleading. The treatment of involuntary psychiatric patients in general hospitals, in order to be safe and effective, requires the resolution of legal, clinical, financial, and architectural issues, as well as problems in the relationship between psychiatric units and other areas of the general hospital.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

The effect of social and care environments on the disclosure practices of nurse midwives relative to methods of pain management in childbirth.

A multivariable model of characteristics in the nurse-patient relationship that influence the disclosure practices of nurses was developed to investigate the effects that characteristics of the nurse midwife, the patient, and the setting have on the disclosure practices reported by nurse midwives. Data were collected by a mailed questionnaire using multiple-choice questions and patient case studies. The questionnaire was sent to a random sample of 500 certified nurse midwives. No association occurred between variations in patient characteristics and the content disclosed by nurse midwives. Many of the patient demographic characteristics were observed to be significantly related to the method and time of disclosure. Results of the study suggested that the social as well as the immediate health-care environment influenced the disclosure of information.

Female↗
PubMedDate not supplied

Molding the future of advanced practice nursing.

During this time when the walls that divide inpatient, outpatient, primary, tertiary, and community care are coming down, society should expect that the nursing profession will prepare and regulate advanced nursing practice for the good of patient care and society as a whole. To do so, schools with clinical practice graduate programs must create a consistent product; professional credentialing bodies must use consistent criteria to acknowledge advanced practice knowledge and expertise; and state boards of nursing must give legal recognition for advanced practice to these same nurses. Within this environment, advanced practice nurses will be prepared to serve society, even if their skills are applied in a variety of roles.

American Nurses' Association↗
PubMed1994

[Improved utilization of simulation facilities "Knowing is not doing it, neither is having seen it done"].

A survey was undertaken in 1992 of second, third and fourth your students (N = 155) of a four year baccalaurius degree course in nursing. A questionnaire was designed to: determine how often the students visited the simulation facilities; identify all factors influencing the frequency with which they used the facilities; make recommendations for better utilization of the facilities and to ascertain the affective response of the students regarding simulated clinical practice sessions. On the strength of the findings the Department concerned decided to allocate a clinical tutor to the simulation laboratories in order to: make the laboratories more accessible to students; identify nursing skills which students found problematic and to schedule compulsory supervised practice sessions; plan and prepare the physical environment for practice sessions; point out the correct application of basic principles during the performance of nursing skills; help the students to apply their cognitive knowledge; and supervise directly or indirectly while students practised nursing skills. Five months after the implementation of the above decisions a statistically significant difference (p.05) was demonstrated in the nursing skills potential between the second year students of 1991 and 1992.

Clinical Competence↗
PubMed2001

Nurse-environment misfit and nursing practice.

AIM OF THE STUDY: The purpose of the following descriptive correlational study was to investigate nurses' responses to the image discrepancy between the public and nurses, and its relationships with their self-concept, job satisfaction and performance. BACKGROUND: It has been long said that nurses live in a dual structure wherein the nurse's journey toward professionalization is constrained by nursing stereotypes in a society. This duality of the nursing universe is assumed to have created a person-environment misfit which could lead to nurses' job dissatisfaction and low job performance. Nonetheless, little study has been done in this area. DESIGN/METHODS: The study was conducted in 1999 with ethical approval from an Australian University. A sample of 80 Australian registered nurses participated by completing the Porter Nursing Image Scale, Index of Work Satisfaction (IWS) and Six-Dimension Scale of Nursing Performance. Data were analysed using descriptive statistics and Pearson correlation. RESULTS: The results suggested that there is a discrepancy in the images of the nursing profession between nurses and the public, which can contribute to the nurse-environment misfit. The results also supported a negative correlation of the misfit with nurses' job satisfaction and performance. CONCLUSION: Despite the limited sample size and characteristics, this study provides evidence to encourage nurses to improve the public image of nurses, which will enhance the professionalization of nursing.

Employee Performance Appraisal↗