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PubMed2000

Knowledge and attitudes of nurses in veterans hospitals about pain management in patients with cancer.

PURPOSE/OBJECTIVES: To assess nurses' knowledge and attitudes about pain management and patients in pain. DESIGN: Exploratory, descriptive. SETTING: Seven medical-surgical inpatient units in two large veterans hospitals in Southwest Florida. SAMPLE: A convenience self-select sample of 85 nurses (RNs and LPNs working on the target units on all shifts). METHODS: Staff nurses were approached at work and asked to complete the data collection forms. MAIN RESEARCH VARIABLES: Knowledge about pain management principles and attitudes toward pain management and patients in pain. FINDINGS: Areas of major knowledge deficits included physiology of pain and pharmacology of analgesics. Nurses were most knowledgeable about the importance of asking patients about their pain, around-the-clock scheduling, tolerance, and use of distraction. Patient behavior, age, and gender seemed to unduly influence nurses in their pain management decisions. Regarding attitudes about pain management, the majority of nurses did not agree that patients and their families should have the most control over analgesic scheduling and that a constant level of analgesic should be maintained in the blood. In fact, 82% indicated that around-the-clock analgesics increase the risk for sedation and respiratory depression. CONCLUSIONS: Years after the Agency for Health Care Policy and Research published pain guidelines, nurses in veterans hospitals continue to lack knowledge and have negative attitudes that may negatively affect pain management in patients with cancer. IMPLICATIONS FOR NURSING PRACTICE: Basic and continuing education for nurses needs to include intensive content about pain management. Continued research is needed to document improvements in pain management by nurses.

Adult↗

PubMed1995

How to benefit from ergonomic interventions through participation by workers, managers and the company: an example of a small- to medium-sized factory with no ergonomic knowledge.

Many of the managers, and supervisors in small- and medium-sized businesses are technicians. These are workers with many years of experience in one specialized technical area. They know, in their minds, what should be improved, and how, in order to make the work easier to do. However, their knowledge of work improvement techniques, and how to think together with the workers, and further how to best lead their troops, is nil. This report focuses on managers and supervisors who had never even heard the word "ergonomics," and touches on cases of successful implementation of ergonomic work improvements. The subject work-places are part of an automobile parts manufacturing plant operating under a typical production system of small amounts of many product types: cutting process machinery workshop, press workshop and packing and distribution workshop. At the stage when they became aware of ergonomics, the key words for improvement which they mentioned were "manual lifting" and "working posture." As a result of various observations, analysis techniques and meetings, they introduced a push car with lifters as support equipment. However, the most significant result was that they were able to convince the company's owner of its contribution to productivity improvement, using objective data. Also, with regard to the push car manufacturer, they designed the specifications for the push car themselves and participated in its production. Of course, they were also praised by the workers for achieving a work method involving no strain or waste.

Automobiles↗

PubMedDate not supplied

Management theory and applications.

Management is critical as an organization pursues its mission. There are many theories of management, but all agree that an effective organizational structure can facilitate the operation of a company. The author describes the typical functional areas found in most organizations (finance, operations, marketing, information systems, legal, and human resources); examines how the organization of tasks and people are inter-linked; and shows that administrators who have a working knowledge of management theory tend to be effective in the performance of their jobs.

Guidelines as Topic↗

PubMed1990

Issues in the management of children with spastic cerebral palsy.

Management of the child with spastic cerebral palsy is multidisciplinary and family-oriented, with emphasis on maintaining and increasing function and preventing deformities. Assessment, family education, and use of multiple forms of therapy in conjunction with assistive technology will result in optimum outcome. The pediatrician must know about and refer children to specialists who are knowledgeable about management of cerebral palsy. Education, vocational training and preparation for independent or assisted living situations are integral parts of management, and the pediatrician must be aware of community resources.

Cerebral Palsy↗

PubMedDate not supplied

[Knowledge, beliefs, and practices related to acute respiratory infections in adults over 65 years old].

Knowledge, beliefs, and practices related to acute respiratory infections (ARIs) in individuals caring for the elderly (over 65 years of age) were evaluated. Home interviews were conducted with 245 persons: 136 lived in urban areas and 109 in rural areas. Mean age was 62 years. All interviewees could read and write. Some 52% of the elderly cared for themselves. A total of 33% smoked. They were generally unaware of the severity of signs and symptoms in ARIs (37% could not mention any). Some 47% did not follow the physician's orders. Self-medication with antibiotics was commonplace. A total of 28% failed to increase liquid intake during the course of ARIs. The results demonstrated insufficient knowledge and management of ARIs in the elderly. An educational program and specific intervention were conducted to improve the situation identified by the study.

Acute Disease↗

PubMed2001

Pediatric trauma. Anesthesia management.

Prevention of childhood injury remains the cornerstone of reducing the number of children who present for post-traumatic surgical intervention. Beyond prevention, the next best step is the accurate diagnosis and treatment of traumatic injury. Anesthesiologists contribute to this step by providing timely resuscitation and optimal care to avoid secondary injury. This article classifies trauma in children into different categories depending on the location of the injury. Trauma, of course, is rarely focal, and is often a multisystem entity. With knowledge in management for each subset of trauma, one may be efficient in prioritizing injury and have a good understanding of the appropriate management of the pediatric patient with multiple traumatic injuries.

Anesthesia↗

PubMed2000

[Operational costs and control of performance in surgical clinics between marketing and planning economics. Risk or perhaps quadrature of the circle].

Surgical hospitals can be seen as operational or even industrial production systems. Doctors have a major impact on both medical performance and costs. For active participation in the management process, knowledge of industrial controlling mechanisms is required. German hospitals currently receive no procedure-related financial revenues, such as prices or tariffs for defined medical treatment activities. Maximum clinical revenues are, furthermore, limited by principles of planned economy and can be increased only slightly by greater medical performance. Costs are the only target that can be autonomously influenced by the management. Operative controlling in hospitals aims at horizontal and vertical coordination of subunits and decentralization of process regulations. Hospital medical performance is not clearly defined, its quantitative measurement very problematic. Process-orientated clinical activities are not taken into account. A high percentage of hospital costs are fixed and can be influenced only by major structural interventions in the long term. Variable costs are primarily dependent on the quantity of clinical activities, but also heavily influenced by patient structure (comorbidity and risk profile). The various forms of industrial cost calculations, such as internal budgeting, internal markets or flexible plan-cost balancing, cannot be directly applied in hospital management. Based on these analyses, current operational concepts and strategic trends are listed to describe cost-management options in hospitals with focus on the German health reforms.

Cost Control↗

PubMed2000

Empowering students on medication for asthma to be active participants in their care: an exploratory study.

This article is part of a larger study of young students with asthma. It focuses on the observations of school nurses and comments from parents and students pertinent to school nursing practice. The study shed light on the educational needs of 9- to 11-year-old students with asthma and identified some areas where the school nurse could easily enhance the health management of these students. Responses from students and parents about asthma provided insight into the daily challenges faced by students with asthma. Students with asthma may or may not fully understand the seriousness of their chronic condition or how to recognize and treat symptoms. The purpose of this pilot study was to identify strategies school nurses might use to determine the knowledge level of students and to determine the effects of asthma education programs. School nurses who participated in the study were provided with a comprehensive package containing current asthma information and an education program to update knowledge and skills. These school nurses also received Open Airways for Schools, an American Lung Association education program for students in grades three to five. The study was a two-group exploratory, quasi-experimental design. Questionnaires were prepared for students, school nurses, and parents to collect information on knowledge and perceptions about asthma. Students who participated in the educational program were reported by their school nurses to have increased knowledge and management skills related to their disease.

Anti-Asthmatic Agents↗

PubMed2006

Developing the health promotion knowledge of the municipalities in South-Savo County in Finland.

Health determinants are not only biology and genetic endowment, but also income and social status, education, employment and working conditions, physical environment, social support networks, healthy childhood development, health services and personal health practices and coping skills. Successful health promotion means working together with local and regional authorities and politicians in every administrative sector in firm cooperation with health education, health professionals and local residents. The project for developing health promotion knowledge in management and decision-making contributes to the requirements of partnership working.

Attitude to Health↗

PubMed2000

[Psychological stress, knowledge and treatment expectation of parents with a child managed by cochlear implant].

UNLABELLED: ESTABLISHED KNOWLEDGE: It is known that parents of hard-of-hearing children suffer from an increase in psychosocial stress. SCIENTIFIC QUESTION: How does the psychosocial situation of parents with children who have cochlear implants change during rehabilitation? AIM OF STUDY: It was the aim of this study to demonstrate how parents evaluate retrospectively their own psychological well-being during the process of rehabilitation. METHODS AND RESULTS: We interviewed 87 parents by questionnaires which were mailed to them. Fifty-seven mothers and 46 fathers responded (59% return rate). Parents reported a significant increase in stress, as perceived by themselves, after the time of diagnosis. Of the parents, 25% continued to suffer from psychic stress during rehabilitation as could be demonstrated by the SCL-90-R questionnaire criteria. The expectations by parents were realistic prior to implantation but thereafter increased significantly with time. CONCLUSIONS: The psychological state of parents during the critical phase, after a diagnosis of deafness has been made for their child, has to be considered. Even after an initial phase of shock, parents seemed to be stressed to an extent that required therapeutic intervention.

Adaptation, Psychological↗

PubMed2001

The Interdisciplinary Generalist Curriculum Project at Nova Southeastern University College of Osteopathic Medicine.

Nova Southeastern University College of Osteopathic Medicine (Nova Southeastern) proposed for its IGC Project to match students with community-based generalist physician role models through partnership with a managed care organization (MCO). An unanticipated corporate merger between the initial managed care partner and another health plan resulted in Nova Southeastern's negotiating training partnerships with multiple MCOS: Other program elements that differed from what was originally proposed include provision of an interactive utilization management session at a hospital or skilled nursing facility, rather than a headquarters-based utilization management rotation; combining multiple learning experiences for students within a single MCO session; having a portion of the training take place at field-based sites outside MCO headquarters or after normal business hours (i.e., MCO physician committee meetings); and recruitment of physician mentors through a variety of means and not just through MCOS: The current goals emphasize preparing students to have a working knowledge of managed care principles and practice that can be applied in any medical field and setting. This goal contrasts with the original goal of preparing students for jobs "within" managed care. The IGC Project is viewed at Nova Southeastern as the flagship of interdisciplinary curricular changes in the training of tomorrow's physicians.

Curriculum↗

PubMed1992

Acute pain in the elderly.

Acute-pain syndromes are common in the elderly. They often occur in association with the degenerative diseases that are likely to affect this age-group. Diagnosis of the specific type of acute pain is made difficult by several factors, including atypical presentation and underreporting. Treatment can be complicated by the polypharmacy that is prevalent among older adults and by age-related physiologic changes. Effective management requires knowledge of the effects of various pharmacologic agents in older adults and of the health and psychosocial status of the individual patient.

Acute Disease↗

PubMedDate not supplied

How to make experience your company's best teacher.

In our personal life, experience is often the best teacher. Not so in corporate life. After a major event--a product failure, a downsizing crisis, or a merger--many companies stumble along, oblivious to the lessons of the past. Mistakes get repeated, but smart decisions do not. Most important, the old ways of thinking are never discussed, so they are still in place to spawn new mishaps. Individuals will often tell you that they understand what went wrong (or right). Yet their insights are rarely shared openly. And they are analyzed and internalized by the company even less frequently. Why? Because managers have few tools with which to capture institutional experience, disseminate its lessons, and translate them into effective action. In an effort to solve this problem, a group of social scientists, business managers, and journalists at MIT have developed and tested a tool called the learning history. It is a written narrative of a company's recent critical event, nearly all of it presented in two columns. In one column, relevant episodes are described by the people who took part in them, were affected by them, or observed them. In the other, learning historians--trained outsiders and knowledgeable insiders--identify recurrent themes in the narrative, pose questions, and raise "undiscussable" issues. The learning history forms the basis for group discussions, both for those involved in the event and for others who also might learn from it. The authors believe that this tool--based on the ancient practice of community storytelling--can build trust, raise important issues, transfer knowledge from one part of a company to another, and help build a body of generalizable knowledge about management.

Communication↗

PubMed1999

[Psychosocial aspects of malignant melanoma].

Psychosocial aspects play a role in every stage of malignant melanoma: they are significant in terms of sun exposure habits (primary prevention) and have an important influence on the time lapse between the onset of malignant melanoma and its diagnosis (secondary prevention). Knowledge about psychosocial aspects is also necessary during the course of illness following primary treatment as during this phase patients make critical efforts in understanding and adapting to their illness. These efforts in turn interact with treatment measures and the course of the illness (tertiary prevention). Effective psychosocial interventions are available that can have an important impact on patients' quality of life. Stage-appropriate disease management requires knowledge of relevant psychosocial aspects during the course of cancer and has practical consequences not only for future prevention measures, but also for individual patients, physician-patient relationship and interdisciplinary patient care.

Adaptation, Psychological↗

PubMed2000

Management of the contralateral breast in patients with hereditary breast cancer.

Approximately 5% of all breast cancers arise on a background of one of the high-risk breast cancer genes (hereditary breast cancer and hereditary breast and ovarian cancer). An estimated 20% of cases arise in the presence of a less striking family history with later average age at onset and lower penetrance, familial breast cancer. For hereditary breast cancer, bilaterality is a recognized feature. Cancers often present at an early age with the contralateral risk high. This article explores the current state of knowledge regarding management options for women with hereditary breast cancer.

Journal Article↗

PubMed2002

Private medical practitioners and managed care in Malaysia: a survey of knowledge and attitudes held by Federal Territory based doctors.

This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.

Adult↗

PubMed2006

Survey of asthma care in Taiwan: a comparison of asthma specialists and general practitioners.

BACKGROUND: Asthma is a common disease in Taiwan. The promotion of quality care for asthmatic patients should focus not only on new treatment remedies but also on patient adherence to treatment and a continuous education program integrated into treatment plans. One reason for patients' poor response to treatment is the lack of asthma knowledge on the part of physicians in terms of attitudes toward treatment. OBJECTIVE: To investigate the current status of asthma treatment among asthma specialists and general practitioners and their relative acceptance of and adherence to treatment guidelines. METHODS: One thousand questionnaires were distributed to physicians throughout Taiwan using a randomized sampling procedure. The questionnaire asked about the use of different kinds of medications, including inhaled corticosteroids, to treat asthma; adherence to asthma treatment guidelines; the use of a peak flow meter for monitoring asthma status; and self-efficacy in the treatment of asthma. RESULTS: A total of 526 questionnaires were returned. Of these, 90.4% of specialists and 63.2% of general practitioners would follow the guidelines for patient care (P = .002). It was significant that 79.8% of specialists but only 41.9% of general practitioners would instruct patients to use a peak flow meter to monitor symptoms (P < .001). Asthma specialists also seemed to be significantly more competent than general practitioners regarding asthma knowledge, instruction of inhalation techniques, use of peak flow meters to monitor symptoms, and making an action plan. CONCLUSIONS: To minimize the knowledge gap between specialists and general practitioners regarding asthma treatment, recognized treatment guidelines need to be popularized or simplified. Furthermore, the continuing education of general practitioners in asthma knowledge and management skills is important.

Administration, Inhalation↗

PubMedDate not supplied

National strategy for mass casualty situations and its effects on the hospital.

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized. The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested. In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs). A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.

Disaster Planning↗