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PubMed1994

The ambulatory oncology nurse's role.

The increasing complexity of cancer care in the ambulatory setting results in the role of the ambulatory oncology nurse being pivotal to ensuring quality health care. Nurses have created a variety of multifaceted roles that include the staff nurse, advanced practice nurse, clinical trials nurse, office nurse, and the head nurse or nurse manager. Common issues encountered by the ambulatory oncology nurse are telephone triage, limitation of time, and transition of care.

Ambulatory Care↗

PubMed2005

Explaining transitions over the hypothesized psychosis continuum.

OBJECTIVES: It is crucial to understand the psychological mechanisms that mediate transition from having one or two psychotic symptoms to becoming a patient with a psychotic disorder. This study investigated whether: (i) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the later onset of clinical psychotic disorder; and (ii) the presence of need for care in relation to psychotic disorder was associated with the use of particular coping strategies. METHOD: A general population sample of 4672 individuals with no lifetime evidence of any psychotic disorder were interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder with need for care. Coping, subjective distress with and perceived control over the psychotic experience were assessed using the Maastricht Assessment of Coping Strategies (MACS). RESULTS: Given the presence of hallucinatory experiences at baseline, the increase in risk on the additive scale of having the psychosis outcome at T2 was higher in the group with delusional ideation at T1 than in those without delusional ideation at T1. Similarly, presence of depressed mood at T1 increased the risk of having the psychosis outcome at T2, but this effect overlapped partly with the risk-increasing effect of delusional ideation. Individuals with a need for care were much more likely to display symptomatic coping, whereas the presence of the other coping types was not different across the groups with and without need for care. CONCLUSION: Transitions over the psychosis continuum are, at least in part, driven by the emotional, cognitive and behavioural responses to the initial psychotic or psychosis-like experiences. Individuals who react with a delusional interpretation, negative emotional states and/or a symptomatic coping style have an increased risk for developing clinical psychosis.

Adaptation, Psychological↗

PubMedDate not supplied

Transition of adolescents with special health care needs: review and analysis of the literature.

A review and analysis of 43 transition studies published from 1982 through 2003 was conducted. The studies reviewed represent the diverse purposes of international researchers for examining transition issues and questions. Findings of this literature review indicate that transition research is in early stages of development. A number of limitations were associated with these studies, including the lack of theoretical frameworks, the use of valid and reliable instruments, and research designs lacking adequate controls. Future research studies are needed that overcome the design limitations of past investigations.

Adolescent↗

PubMed1997

Management of adults with congenital heart disease: an increasing problem.

A small new population of patients in cardiology, the grown-up (adult) congenital hearts (GUCH), need superspecialist care and expertise, particularly those patients with complex defects previously operated on in childhood or who were not operated on. Arrhythmias are the most common cardiologic reason for admission to the hospital, and atrial flutter is the most frequent disorder of rhythm, usually related to hemodynamic disturbances. The GUCHs need solutions to problems of transition of care, ideally an adolescent area for the younger patients, knowledge of which and when to investigate each anomaly, expertise in cardiac catheterization and interventions, cardiac surgeons experienced in congenital as well as adult disease since one in five admissions are for cardiac surgery, at-risk pregnancy service, counseling on life's problems, and most of all a few dedicated centers with cardiologists and surgeons trained in this subspecialty. The profession needs to achieve optimal care for these precious patients, particularly those with complicated lesions and complex surgery, particularly with the valve replacements. Although small in number and high in expense, GUCH patients should be centralized so expertise and experience can be concentrated despite the need to cross barriers of finance and bureaucracy. Currently, with the exception of a few expert centers, these patients receive suboptimal medical management.

Adolescent↗

PubMed2002

The transition into adulthood for children and youth with special health care needs.

With advances in medical care, children with chronic medical conditions are living longer lives. They, their families, and their health care professionals are faced with new challenges: transition from pediatric care into adult medical care and meeting the vocational, educational, and other social needs to make this transition of children and youth with special health care needs successful. This article identifies problems and proposed solutions to start to make this transition more successful, including the results of working meetings of representatives from Texas, Oklahoma, New Mexico, and Arkansas.

Adolescent↗

PubMed2006

Young adults with learning disabilities: a study of psychosocial functioning at transition to adult services.

A study of the psychosocial functioning of young adults with a history of learning disability (LD) in childhood is reported. The design was a non-clinic community follow-up investigation of a cohort of children who had received special education, the sample frame for which was a birth-period cohort survey. Participants were 149 young adults (89 males and 60 females derived from a survey of the 33,800 children born in the Cambridge Health District between 1967 and 1973) at the stage of transition to adult services (age 18-22y), whose measured IQ scores in childhood were <80, and who had received special education during school years. Most of the young adults were living at home (n=108) and many were in full-time employment (independent employment n=41, sheltered employment n=20), this survey having been carried out in an area of high employment. A strong correlation was found between the child IQ score and subsequent adult Vineland Scale Score. Greater efforts should be made to detect and assess LD and its attendant problems in children in order to plan future care and transition to adulthood, especially for those with more severe disabilities.

Adolescent↗

PubMed1994

Transition from Pediatric to Adult-Oriented Health Care for the Adolescent with Chronic Illness or Disability.

Adolescents and young adults with chronic conditions are given fewer opportunities to be independent health care consumers than their peers, and the transition from pediatric to adult-oriented care can be particularly difficult. For many chronically ill patients, transition medical services may be appropriate. The need for such services and ways to provide them are discussed.

Journal Article↗

PubMed2001

Approach to optimal care at end of life.

At no other time in any patient's life is the team approach to care more important than at the end of life. The demands and challenges of end-of-life care (ELC) tax all physicians at some point. There is no other profession that is charged with this ultimate responsibility. No discipline in medicine is immune to the issues of end-of-life care except perhaps, ironically, pathology. This presentation addresses the issues, options, and challenges of providing optimal care at the end of life. It looks at the principles of ELC, barriers to good ELC, and what patients and families expect from ELC. Barriers to ELC include financial restrictions, inadequate care-givers, community support, legal issues, legislative issues, training needs, coordination of care, hospice care, and transitions for the patients and families. The legal aspects of physician-assisted suicide is presented as well as the approach of the American Osteopathic Association to ensure better education for physicians in the principles of ELC.

Caregivers↗

PubMed2001

Transition from pediatric to adult-oriented health care: a challenge for patients with chronic disease.

Pediatric providers can expect that 1 of every 10 patients they see will have a chronic, activity-limiting health condition. Thanks to earlier diagnosis and improved therapies, most of these children will live well into adulthood. This means that eventually they will require care that focuses on adult health issues. Providers in the United States and around the world are recognizing the need for coordinated processes to transition adolescents and young adults with chronic conditions to adult health care. These models rely on the participation and input of the adolescent, his or her family, and pediatric and adult health professionals. This paper distinguishes medical transition from medical transfer; discusses potential barriers to transition; examines new initiatives to develop and study transition models; and reviews federal legislation influencing health care transitions.

Adolescent↗

PubMed1997

Quality: the next six months.

The eclectic mix of participants in the forum had a surprisingly singular focus when it came to the topic of quality in clinical laboratories. All sensed that the time is right for a transition from laws, rules, and inspections to a true quality-based system. Such a system can achieve the goals, implicit and explicit, that are the rationale for the multiplicity of regulations affecting today's laboratories. A true quality-based system has great potential benefits to laboratories, regulators, and manufacturers, and ultimately to our true customers, the patients. The benefits include lower costs, superior products, and better test results; in short, better patient care. This transition will be possible only through formation of a "Quality Alliance," composed of those skilled in the "theory" of quality-laboratory personnel, manufacturers, and regulators, acting as one to implement the quality system. The Quality Alliance requires a team of individuals with different skills, aligned as one, for the purpose of achieving a common goal. On the basis of views expressed in this Forum, our collective future will be defined by the evolving Quality Alliance, an alliance focused on true quality systems in clinical laboratories.

Chemistry, Clinical↗

PubMed1990

First-time expectant fatherhood: nursing care considerations.

The transition to parenthood is a major life event for a man, yet, for the most part, the father remains a stranger, overshadowed by the mother. A brief summary of the author's research findings related to the male experience of expectant and new fatherhood is presented and utilized as the basis for discussion of nursing actions during the antepartum period to support and promote the male transition to parenthood.

Adaptation, Psychological↗

PubMed2001

The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part two.

This is the second of a two-part paper which explores the areas of commonality and synchronicity between palliative care (PC) nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non-physical care, the nurse--client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation and the focus on physical care. Part one focused on the first three areas of commonality, whereas this paper focuses on the fourth commonality, the locus of control. It also focuses on key differences and the implications of such similarity. The paper highlights the practice, education and research implications of this alleged commonality. It suggests, given the evidence that clients perceive the therapeutic relationship as the vital and unique aspect of PC nursing, that those working within palliative care need to question whether or not RGN registration is an essential requirement, or whether those with other skills, such as psychiatric/mental health (P/MH) nurses, should be considered for such roles. It highlights the need for the provision of post-basic counselling courses and the potential value for PC nurses of receiving clinical supervision from P/MH nurses or mental health liaison nurses. Lastly, it posits that the research issues arising out of this alleged commonality centre on the potential impact such transitions in care delivery may have on the care delivered, on the nurses themselves and on the clients.

Curriculum↗

PubMedDate not supplied

Easing the transition from hospital nursing to home care: a research study.

With the increased need for staff nurses, home healthcare agencies can ease the transition for experienced nurses who have worked in settings other than the home. Formal instruction, employment orientation, and preceptorship can effectively prepare new home care nurses for their duties.

Adaptation, Psychological↗

PubMed1983

Selection criteria for pediatric critical care transport teams.

The primary goal of an interhospital critical care transport program is to provide quality medical care during transit as close as possible to that available in the receiving ICU. Critically ill pediatric patients are transported between hospitals by a variety of transport teams. The skills possessed by physicians, nurses, respiratory therapists, and paramedics overlap. To determine the criteria for selection of the team members for these patients, we reviewed the medical records of 115 pediatric patients transported to this facility in 1978 and 1979. Patients were categorized by diagnosis, severity of illness at the time of transport, and the monitoring and life support required during transport. Our data indicate the medical transport team members should have skills required for pediatric critical care diagnosis and management including endotracheal intubation and assisted ventilation; insertion of peripheral, central venous, and arterial catheters; fluid and electrolyte therapy; antibiotic therapy; cardiovascular monitoring; and pharmacological life support. The team members should be chosen based on the particular skills needed for a transport with a goal of providing the patient care required on a consistent basis.

Adolescent↗

PubMed2003

Asthma in adolescence.

The care of adolescents with asthma has been largely neglected, yet adolescents have particular needs that differ from those of children or adults with asthma. There are over 800,000 teenagers in the UK who suffer from asthma and underdiagnosis and poor treatment are common. The prevalence and level of morbidity from asthma in adolescents are as high as or higher than the rates in younger schoolchildren. Poor symptom control frequently reflects poor compliance with treatment. The beliefs and fears of teenagers about their asthma and its treatment are often not recognised or addressed in clinical consultations. Improved communication on the part of health professionals, which results in negotiating simple management plans that are tailored to the individual patient's concerns and goals, is more likely to improve compliance and asthma control than are complex plans made unilaterally by the doctor. The transition of care from the paediatric to the adult clinic remains a challenge for paediatricians and there is a lack of consensus over the best method of achieving this.

Activities of Daily Living↗

PubMed2002

Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK.

This report addresses the needs and problems of grown-up congenital heart (GUCH) patients and makes recommendations on organisation of national medical care, training of specialists, and education of the profession. The size of the national population of patients with grown-up congenital heart disease (GUCH) is uncertain, but since 80-85% of patients born with congenital heart disease now survive to adulthood (age 16 years), an annual increase of 2500 can be anticipated according to birth rate. Organisation of medical care is haphazard with only three of 18 cardiac surgical centres operating on over 30 cases per annum and only two established specialised units fully equipped and staffed. Not all grown-ups with congenital heart disease require the same level of expertise; 20-25% are complex, rare, etc, and require life long expert supervision and/or intervention; a further 35-40% require access to expert consultation. The rest, about 40%, have simple or cured diseases and need little or no specialist expertise. The size of the population needing expertise is small in comparison to coronary and hypertensive disease, aging, and increasing in complexity. It requires expert cardiac surgery and specialised medical cardiology, intensive care, electrophysiology, imaging and interventions, "at risk" pregnancy services, connection to transplant services familiar with their basic problem, clinical nurse specialist advisors, and trained nurses. An integrated national service is described with 4-6 specialist units established within adult cardiology, ideally in relation or proximity to university hospital/departments in appropriate geographic location, based in association with established paediatric cardiac surgical centres with designated inpatient and outpatient facilities for grown-up patients with congenital heart disease. Specialist units should accept responsibility for educating the profession, training the specialists, cooperative research, receiving patients "out of region", sharing particular skills between each other, and they must liaise with other services and trusts in the health service, particularly specified outpatient clinics in district and regional centres. Not every regional cardiac centre requires a full GUCH specialised service since there are too few patients. Complex patients need to be concentrated for expertise, experience, and optimal management. Transition of care from paediatric to adult supervision should be routine, around age 16 years, flexibly managed, smooth, and explained to patient and family. Each patient should be entered into a local database and a national registry needs to be established. The Department of Health should accept responsibility of dissemination of information on special needs of such patients. The GUCH Patients' Association is active in helping with lifestyle and social problems. Easy access to specialised care for those with complex heart disease is crucial if the nation accepts, as it should, continued medical responsibility to provide optimal medical care for GUCH patients.

Adolescent↗

PubMed1999

Issues in the transition from childhood to adult growth hormone therapy.

The consequences of severe growth hormone deficiency (GHD) in adults and the beneficial effects of GH replacement therapy are clear. However, the majority of children who have a diagnosis of GHD and who are treated with GH do not have permanent GHD and will not require treatment during adulthood. Several issues must be considered in selecting candidates for adult GH treatment and transitioning their care from pediatrics to adult medicine. Counseling about possible lifelong treatment should focus on children with panhypopituitarism and those with severe isolated GHD that is associated with central nervous system abnormalities. When to terminate growth-promoting GH therapy should be guided by balancing the high cost of late-adolescent treatment with the attainment of reasonable statural goals. Retesting for GH secretion is appropriate for all candidates for adult GH therapy; the GH axis can be tested within weeks after the cessation of treatment, but confirming an emerging adult GHD state with body composition, blood lipid, and quality-of-life assessments may require 1 year or more of observation. Selecting patients for lifelong adult GH replacement therapy will present diagnostic, therapeutic, and ethical problems similar to those in treating childhood GHD. The experience and expertise of pediatric endocrinologists in diagnosing and treating GHD should be offered and used in identifying and transitioning appropriate patients to adult GH therapy.

Adult↗

PubMed1990

The reorganization of the nursing labor process: from team to primary nursing.

The author presents a labor process analysis of recent changes in nursing work on hospital wards. In the immediate post-World War II decades, hospital nursing was organized to include stratified nurses--registered and auxiliary nurses (licensed practical nurses and nurses' aides)--in a common labor process called "team nursing." Team nursing adapted Taylorist principles to sharply demarcate tasks between registered nurses (RNs) and auxiliaries. In the 1970s and 1980s, team nursing increasingly replaced by "primary nursing" with a majority of RNs. Auxiliaries were displaced as RNs assumed undivided responsibility for complete nursing care. The transition to primary nursing is partly explained through the convergence of managerial interests with the professionalizing interests of nursing's elite. However, primary nursing was not simply imposed from the top down. Team nursing produced divisiveness between RNs and auxiliaries at the same time that it forced these workers to violate the official differentiation of tasks and held RNs responsible for work performed by auxiliaries. Primary nursing eliminates the problems of team nursing as RNs perform reunified tasks in an unmediated RN-patient relationship. However, primary nursing has produced a new set of contradictions, including an intensified labor process.

Cost Control↗