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PubMedDate not supplied

Using role theory concepts to understand transitions from hospital-based nursing practice to home care nursing.

BACKGROUND: The phenomena experienced by professional nurses who make practice-based career changes are seldom addressed in the literature. Nurses changing from a hospital-based practice to a home health care setting report feelings of anxiety, incompetency, and lack of the necessary skills to care for clients in the home. METHOD: An integrative review of the literature on role theory can provide the conceptual understanding of the transitional experience of nurses whose roles change when they move from hospital-based practice to a home health care setting. RESULTS: A model of the role transition process is helpful in identifying the transition experienced by nurses new to the home health care setting. Experiences during the initial transition period are critical in shaping the nurse's understanding of the role. CONCLUSION: Educators can play a key part in assisting novice home health care nurses with role enactment by developing comprehensive orientation and education programs aimed at minimizing role strain.

Attitude of Health Personnel↗

PubMed2001

Temperature and heater responses during transition between radiant and incubator thermal environment in newborn preterm lambs.

OBJECTIVE: Although both incubators and radiant warmer beds can provide thermal support to infants in the neonatal intensive care unit, the transition between devices can be a stressful event. The goal of this study was to evaluate a new device that combines these methods of warming and converts between them without requiring physical movement of the infant. STUDY DESIGN: Twin preterm lambs received thermal support from a radiant warmer bed and an incubator (control), or from the Versalet 7700 Care Center (treatment) in the warmer and incubator configurations. Temperature of each lamb, as well as device heater power, were monitored every 2 min before, during, and after the transition. Physiological parameters were monitored every 15 min. RESULTS: There was a significant difference in response time between closed-open and open-closed conditions for both groups. More adverse events occurred in the control group during transfers. There were no differences in temperatures or physiological variables during transitions in either group. CONCLUSIONS: These data suggest the Versalet provides similar thermal stability to traditional devices, with fewer adverse events associated with the lack of physical movement between warming configurations. The impact of this device on the care of the preterm neonate will be evaluated in a clinical trial.

Animals↗

PubMed1999

Measuring Physicians' Performances and Marketing the RESULTS: A Breast Cancer Model.

The recent transition to managed care has intensified the public's concerns about the quality of medical care. In response, payers, who until recently seemed preoccupied with costs, are demonstrating a renewed interest in value, which in turn could lead to an expansion of negotiations with physicians to include the tracking of such issues as physician performance, patient satisfaction, and patient outcomes. As a response to public concern and demand for accountability, the medical establishment must develop methods to assist payers in estimating relative value of competing medical services. In anticipation of a values transition in their specialty, breast care, the authors established a performance-oriented database which facilitated assessments of their performance in relation to community standards, and enhanced efforts to identify and correct performance deficiencies. Year-end results were summarized in a report-card format that improved marketability. The author's experiences should be of interest to physicians who are attempting to respond to changes in the rapidly evolving medical marketplace.

Journal Article↗

PubMed1998

Organization of health care in Croatia: needs and priorities.

AIM: Description and analysis of the present situation of health care system in Croatia, and its characteristics in the transitional process of restructuring. METHODS: A descriptive method was used. The data from the regular statistical publications were used for the analysis. RESULTS: Croatia is faced with problems similar to those in other countries of the Central and Eastern Europe (CEE), such as control of health expenditure, balancing the development of different segments of health care services, stabilization of effectiveness and quality of care, transition from one-party system to pluralistic democracy, introduction of a free market economy, war devastations, etc. On the other hand, the Croatian experience in the development of a decentralized and integrated primary health care, decentralized health insurance system, education of general/family practitioners, and a tradition in the implementation and development of public health measures, have facilitated and contributed positively to the whole process of transition. CONCLUSION: In contrast to the economic difficulties, war devastations, and changing the social system, the Croatian health care system proved its stability and sustainability. The highest priority and needs are now related to coping with unhealthy behavior of the population, such as smoking, accidents, physical inactivity, and nutritional problems, which should be solved and controlled by the implementation of preventive programs, organization and management of public health services, and further focusing onto the integrated type of primary health care in the organization of services. Hospital services need more intensive and skilled management, as well as support measures for better quality of work.

Croatia↗

PubMed1999

Nothing exceeds like success: managed care comes to Medicaid in New York City.

Nearly every state is encouraging or requiring Medicaid beneficiaries to enroll in managed care delivery systems. In New York City, Medicaid officials began with an incremental, but not insignificant, managed care initiative. Buoyed by its success, New York policy makers tried, and failed, to accelerate the transition to managed care. The legacy of that failure still plagues them. A comparison of such initiatives in other states indicates that most state officials have remembered what New York's leaders temporarily forgot, namely, that Medicaid managed care is a complex exercise that demands consultation and consensus building.

Health Care Reform↗

PubMed2005

[Concepts of mental health and care according to mentally-ill patients and their relatives].

This study aimed at 1) identifying social, demographic and clinical characteristics of mentally-ill patients and their relatives and 2) analyzing their conceptions concerning mental illness and psychiatric care. The Attitude Measurement Scale (AMS) was used. Quantitative and qualitative analyses of the data were carried out. The 104 study subjects comprised 35 patients and 69 relatives (n=104). The Mann-Whitney Test was used for comparing the opinions of patients X relatives and the Wilcoxon Test for comparing Concept and Care. There was homogeneity in the distribution of the subjects' scores for both Concept and Care. No questions stood out or were concentrated in either group. The subjects' profile shows the transition from asylum care to innovative experiences, although there is still a concentration of drug treatments and dependence on the psychiatric institution.

Adult↗

PubMed2004

Measuring continuity of care for cardiac patients: development of a patient self-report questionnaire.

BACKGROUND: Continuity of care can be a challenge for cardiac patients, many of whom require chronic and complex management from a variety of health care personnel in multiple settings. For health services research, measures are needed that encompass the multifaceted nature of continuity of care for cardiac patients. OBJECTIVE: To assess continuity of care from the patient's perspective, a comprehensive self-report instrument of continuity of care for patients with congestive heart failure and atrial fibrillation was developed and validated. METHODS: Based on published work, patient interviews and provider input, the Heart Continuity of Care Questionnaire (HCCQ) was developed to assess various aspects of care in the transition from hospital to home. The HCCQ covered a variety of content areas relevant to cardiac care. The HCCQ and either the Continuity of Care Index (CCI) or the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were completed by 83 patients who had been discharged for at least six months. RESULTS: Most items had good response rates. The subscales, defined a priori, had good reliability (subscales alpha ranged from 0.80 to 0.93). The HCCQ and its subscales had strong correlations with the CCI but not the MLHFQ. The HCCQ subscales demonstrated better known group validity than the CCI. CONCLUSIONS: In this preliminary study, the HCCQ appears to be a comprehensive, reliable and valid measure of continuity of care from the patient perspective. Further studies of the validity, generalizability and use are needed.

Adult↗

PubMed1996

Ambulatory systems for managed care.

Providence Health System is successfully making the transition from an acute care-based holding company of health care business to a diversified, operating, managed care company with the mission of improving the health status of the populations it serves, and being at financial risk for doing so. Information systems have been a leading change agent in this transition, not only from the standpoint of consolidating and standardizing practices within Providence Health System, but also by facilitating the exchange and integration of information within the health care community. ProvNet has made available the tools to accomplish this information integration in the physician's office and to extend it not only to Providence, but to other health systems as well.

Ambulatory Care Information Systems↗

PubMed1999

'Coming out' as a life transition: homosexual identity formation and its implications for health care practice.

This paper explores the formation of homosexual identity through the complex transitional process of 'coming out'. Linear developmental models are discussed as is the influence of societal norms on identity formation. In considering the implications for professional practice the author challenges the heterosexism in health care and suggests ways in which health care professionals can provide a supportive environment for gay men and lesbians.

Female↗

PubMed1994

The transition to continuous quality improvement: a home care model.

Managers of home care organizations in the 1990s are faced with serious challenges. The magnitude of change occurring makes it difficult to distinguish a reasonable course of action. Quality improvement techniques offer an exciting opportunity for organizations to regain control of their strengths by identifying and improving their weaknesses. This article presents a transitional model for quality improvement involving structure, process, and outcome variables adapted to home care organizations. It encompasses unique committee structures mandated by licensure and certification requirements, which can be adapted to quality improvement focus. Finally, it identifies customer service trends that provide managers with information to fine-tune good business practice.

Home Care Services↗

PubMedDate not supplied

Transition from paediatric to adult-orientated care for adolescents with cystic fibrosis.

Adolescence is a time of major physical and psychological change. Young teenagers need to become comfortable with their developing sexuality, to begin moving towards independence with a greater reliance on peer group acceptance, to face the future and to make important decisions about their education, career and goals. Difficulties inherent in all of these steps to adult life are magnified by chronic ill health. It is harder for adolescent patients to break family ties, harder to feel accepted by their peer group, harder to plan realistically for the future. It must be the overriding aim of the professional health carers to encourage these patients to confront the problems of adolescence and to help them maintain their physical and emotional stability throughout this challenging period. Parents also must be supported, and encouraged gradually to devolve to their child responsibilities for decision making and for taking prescribed medication. A planned and sensitive transition from a paediatric to an adult health-care system will aid a successful evolution to an independent adult life. The paediatric hospital environment is not best equipped to deal with the problems of adolescence. Just as parents must allow their child to move on, so the paediatric caring team must loosen its ties with the patient and allow transfer to the adult team. There are several ways of effecting this transfer of care. None of them is proven to be better than any other, but the transfer should always be planned, smooth, efficient and expected by the patient. Ideally, all patients should have the opportunity to transfer to a properly equipped and properly staffed adult cystic fibrosis centre where they can continue to receive the highest standards of care from an experienced multidisciplinary team.

Adaptation, Psychological↗

PubMed2002

Health and long-term care use trajectories of older disabled women.

PURPOSE: I examined health and long-term care use trajectories of a sample of chronically disabled older women eligible for both Medicare and Medicaid by exploring their use data in order to understand and anticipate the increasing demand on the health and long-term care delivery systems as aging female baby boomers reach age 65 and older. DESIGN AND METHODS: A sample of older disabled women in Ohio who completed preadmission review was divided into three groups on the basis of the setting in which they received their initial long-term care services. RESULTS: I was able to establish a long-term care career for the sample members beginning with receiving long-term care in the community, followed by a transition stage in which care was received in the community and in a nursing home, and finally by a stage at which they entered and remained in a nursing home. As the sample members proceeded along their long-term care career and their health and disability status worsened, I found a clear shift in the kind of care needed from hospital and home care to nursing home care. There was also a shift in the major payer, from Medicare to Medicaid. IMPLICATIONS: As the baby boomers age, a much larger number of women will be disabled and need health and long-term care services. For a considerable number of these women, Medicaid gradually becomes the major payer for care, an issue that needs close observation.

Aged↗

PubMed1994

Noninvasive nasal mask ventilation for acute respiratory failure. Institution of a new therapeutic technology for routine use.

OBJECTIVE: We successfully implemented the delivery of noninvasive mechanical ventilation for patients with acute respiratory failure, a previously controversial use of this technique, using a simplified ventilator (BiPAP) with nasal mask. Pilot work showed this mode of support to be effective when administered by the members of a research team, and in the current study we were able to transfer this responsibility to usual care providers. SETTING: Almost 90 percent of the patients in this study were in either the 16-bed medical or 31-bed surgical intensive care units at our hospital. SUBJECTS: One hundred ten hemodynamically stable patients with acute respiratory failure being considered for intubation and mechanical ventilation participated in this study. Eighty percent were surgical patients, most of whom had hypercapnic failure. INTERVENTION: Patients were administered noninvasive ventilatory support using a ventilatory support system (BiPAP) applied with a nasal mask. This intervention was administered by a research team in the initial 31 patients (special care, phase 1). The administration was transferred to usual care personnel in the next 45 patients (transition, phase 2). Usual care personnel almost exclusively administered care in the final 34 patients (usual care, phase 3). RESULTS: Withdrawal of ventilatory support for greater than 48 h (successful outcome) was about the same during usual care (phase 3, 80 percent) as it was during special care (phase 1, 76 percent).

Acute Disease↗

PubMed2002

The power of servant leadership to transform health care organizations for the 21st-century economy.

Physician leadership is emerging as a vital component in transforming the nation's health care industry. Because few physicians have been introduced to the large body of literature on leadership and organizations, we herein provide a concise review, as this literature relates to competitive health care organizations and the leaders who serve them. Although the US health care industry has transitioned to a dynamic market economy governed by a wide range of internal and external forces, health care organizations continue to be dominated by leaders who practice an outmoded transactional style of leadership and by organizational hierarchies that are inherently stagnant. In contrast, outside the health care sector, service industries have repeatedly demonstrated that transformational, situational, and servant leadership styles are most successful in energizing human resources within organizations. This optimization of intellectual capital is further enhanced by transforming organizations into adaptable learning organizations where traditional institutional hierarchies are flattened and efforts to evoke change are typically team driven and mission oriented.

Delivery of Health Care↗

PubMed2006

Advanced practice nurse strategies to improve outcomes and reduce cost in elders with heart failure.

The aim of this study was to investigate whether, in a randomized controlled trial (RCT) of vulnerable elders with heart failure (HF), advanced practice nurses (APNs) who were coordinating care in the transition from hospital to home could improve outcomes, prevent rehospitalizations, and reduce costs when compared with usual care. The APN strategies focused on improving patient and family or caregiver effectiveness in managing their illnesses, strengthening the patient-provider relationship, and managing comorbid conditions while improving overall health. The results were positive. By capitalizing on the patient's desire to achieve their identified goals, APNs successfully educated patients about the meaning of their symptoms and appropriate self-management strategies; improved patient-provider communication patterns; and marshaled caregiver and community resources to maximize patient adherence to the treatment plan and overall quality of life. While HF was the primary reason for enrollment in the study, optimal health outcomes demanded a strong focus on integrating management of comorbid conditions and other long-standing health problems. Specific strategies used by the APN to achieve these positive outcomes are addressed in this report. These strategies are compared with nursing interventions used in other RCTs of HF home management. Directions for future research are explored.

Aged↗

PubMed1995

Stay in residential facilities and mental health care as predictors of readmission for patients with substance use disorders.

OBJECTIVES: This study examined the relationship between substance abuse patients' length of stay in community residential facilities and their outpatient mental health aftercare and readmission for inpatient care. METHODS: A national sample of 1,070 substance abuse patients referred to community residential facilities after an episode of inpatient care was assessed and followed over four years. Patients were divided into three groups: those with only alcohol-related diagnoses; those with drug-related diagnoses, most of whom also had alcohol diagnoses; and those with concomitant psychiatric diagnoses. RESULTS: Patients who had longer episodes of care in residential facilities were more likely to obtain outpatient mental health aftercare and were less likely to be readmitted for additional substance abuse or psychiatric care in six-month, one-year, and four-year follow-up intervals. Readmission rates among substance abuse patients with psychiatric diagnoses were much higher than rates among patients who had only substance abuse diagnoses. Length of stay in the community residential facility and postdischarge outpatient mental health care remained significant independent predictors of lower readmission after other risk factors for readmission were considered. CONCLUSIONS: Transitional community residential care can contribute to substance abuse patients' treatment outcome; however, longer-term supportive care is needed for substance abuse patients with more severe and chronic disorders.

Adult↗

PubMed1990

Hospice: social work's response to a new form of social caring.

Social work's response to hospice, as a new form of social caring, is portrayed by a social work process paradigm, conceptualized from the practice and research experiences of the authors. Guidelines are suggested for working with patients, families, care providers, and other concerned persons through the four phases of hospice care. As changes occur in the patient and the hospice settings, the participants join together to bring about a satisfactory fit between the person needing care and the environment. By anticipating the needs and reactions of the terminally ill patient to each transition in the care process, the social worker assists in orchestrating proactive interventions through the continuum of hospice care. Future research studies are recommended for determining what difference social work actions make toward ensuring a "safe passage."

Adaptation, Psychological↗

PubMed2002

Looking at the future of geriatric care in developing countries.

During the next 20 years, many less developed countries (LDC) will have age structures approaching those of the present time in more developed countries (MDC). This is occurring more rapidly in the LDC of Asia and Latin America. The future of aging populations in LDC is dependent on the degree of poverty in these countries. Poverty is a major determinant of disability and mortality in older persons. With the march of globalization, diseases in LDC are changing from infectious to noncommunicable diseases, such as diabetes. Nevertheless, infections such as tuberculosis still take a major toll on the elderly. The epidemiological transition in LDC has created a need for health care transitions from systems based on cure to ones that highlight prevention and long-term care. LDC have the opportunity to develop systems that differ from those in MDC by capitalizing on the lack of infrastructure to produce more home-based rather than institution-based long-term care systems. Involvement of the elderly in the planning of their own futures is of paramount importance. Appropriate planning now will decide the future of the elderly in LDC during the next 20 to 40 years.

Aged↗