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PubMed1987

The clinical nurse researcher: institutionalizing the role.

The role of the clinical nurse researcher is central to the conduct of clinically relevant research and the integration of research findings into nursing practice, particularly within inpatient settings. Interviews with clinical nurse researchers revealed that implementation of the role occured under four major models: nursing research unit, dual roles, collaborative roles, and functional role division. Organizational and colleague support were critical to the visibility and viability of the clinical nurse researcher role.

Health Facilities↗
PubMed1992

Strategic vision or strategic con?: Rhetoric or reality?

Major companies devote considerable effort to communicating corporate visions and missions. Yet three recent surveys suggest that much of this effort has been counter-productive. A gap has emerged between rhetoric and reality. Arenas of confrontation have arisen between directors and managers, head offices and business units, holding companies and their subsidiaries, and between specialists and generalists. A widespread desire for corporate transformation is not matched by understanding of how to bring it about. The lack of top management commitment and of communication skills are major barriers to change. More competent directors and more effective boards are needed. The article suggests key roles for the chairman and the chief executive. It examines how best to share a compelling vision, and identifies a requirement for new attitudes and approaches to communication.

Administrative Personnel↗
PubMed1981

The family in consultation--liaison psychiatry.

This article calls attention to an underemphasized aspect of consultation-liaison psychiatry: the importance of the family in the management of illness response. Recent trends in family dynamics have focused primarily on family therapy and less on the critical role family members play in the "coloration," course, and outcome of acute episodes of illness. Case vignettes illustrate examples of intervention by liaison team members in the care of hospitalized medical-surgical patients. The authors suggest that a typology of family response to illness and hospitalization would offer a useful framework for diagnosis, evaluation, and management of the psychosocial aspects of illness. A coordinated approach by liaison team members is important to ensure comprehensive treatment.

Aged↗
PubMed1981

Team tension as a vital sign.

Current efforts to provide comprehensive health care have accentuated the need for new models that integrate the biological, psychological, and social fields. One approach to meeting this need has been the development of health care teams. However, the multidisciplinary perspectives of such teams often result in tension and discord. While this tension may be partly attributable to institutional or professional biases or lack of adequate decision-making techniques, it may also be an essential diagnostic tool for exploring and integrating the paradoxes of the patient's homeostatic system. This approach captures and bridges some of the inadequacies of our prevailing knowledge base. The team's tension can be experienced as an essential empathic connectedness to the patient's life situation. Resolution of the team's internalized conflict becomes a paradigm for the patient's reintegration of his or her own paradoxical or contradictory needs.

Conflict, Psychological↗
PubMed1991

Patterns of referral from consultation-liaison to social work services.

Despite their importance, the nature and context of referral patterns among mental health disciplines in the general hospital has not been sufficiently explored. This study focuses on consultation-liaison (C-L) psychiatry patterns of referral to social work services (SWS). From a structured data base of 1170 consults, it was observed that C-L referred 24% of the cases seen by psychiatry. Psychiatry was more likely to refer those who are: female (p = less than 0.05), living with others (p = less than 0.05), described as less urgent (p = less than 0.05), diagnosed with personality disorders (p = less than 0.01), under greater psychosocial stress (Axis IV) (p = less than 0.001), and evaluated as having better functional status (Axis V) (p = less than 0.001). Regression analysis revealed that four variables had the greatest impact on differentiating those C-L referred to SWS from the "others": 1) constant observation recommended (log -586, p = 0.0001); 2) type of psychiatric management (log -573, p = 0.0001); 3) Medicaid insurance (log -564, p = 0.0001); and 4) original referral for the consultation was the refusal of tests or medical treatment (log -559, p = 0.002).

Anxiety Disorders↗
PubMed1992

Nurse-physician collaboration: solving the nursing shortage crisis.

The current severe nursing shortage in the United States has many causes and its solution requires new strategies. Collaboration among the American Association of Critical-Care Nurses (AACN), the Society of Critical Care Medicine (SCCM) and the American College of Cardiology (ACC) has provided a model for the multidisciplinary approach needed. Nurse-physician collaboration is an important strategy to address the ongoing shortage.

Critical Care↗
PubMed2006

Coordinating integrated services: a pilot study with participants of a co-ordinators course.

The aim of this study was to explore developments in integrative practice in cancer care. Views were drawn from a small focus group (n=4), with students from a coordinators course. The role of a coordinator or team leader has been suggested as pivotal to service integration and organisation [National guidelines for the use of complementary therapies in supportive and palliative care. The Prince of Wales's foundation for Integrated Health & The National Council for Hospice and Specialist Palliative Care Services London POWFIH, 2003; Mackereth, European Journal of Oncology Nursing 8 (2004) 1]. The participants suggested that there are areas which need to be developed to achieve this goal, including evidence based practice, standardisation of training, and ongoing support, and personal development.

Attitude of Health Personnel↗
PubMed2006

TuBaFrost 3: regulatory and ethical issues on the exchange of residual tissue for research across Europe.

The regulatory regimes for research with residual tissue and accompanying data differ widely between countries in the European Union (EU): from specific consent to opt-out or even no consent at all. This could greatly hamper research where the exchange of tissue and accompanying data has become the gold standard, like in TubaFrost. Instead of adhering to international guidelines, which have a democratic deficit, or an attempt for a new set of possible harmonising rules, TubaFrost chose to create a coordinating rule: if tissue may legitimately be used for a certain kind of research in the country where it was taken and under whose jurisdiction the patient falls, it may also be used for such research in the country where it is sent to in the context of a scientific program even if in that other country other regulations would apply for research with residual tissue taken from patients under their jurisdiction. This coordinating rule has a sound basis in EU law in general and will solve the problems related to diverging national regulatory regimes in the case of cross national research with residual tissue.

Ethics, Research↗
PubMed2006

TuBaFrost 4: access rules and incentives for a European tumour bank.

When designing infrastructure for a networked virtual tumour bank (samples remain at the collector institutes and sample data are collected in a searchable central database), it is apparent that this can only function properly after developing an adequate set of rules for use and access. These rules must include sufficient incentives for the tissue sample collectors to remain active within the network and maintain sufficient sample levels in the local bank. These requirements resulted in a key TuBaFrost rule, stating that the custodianship of the samples remains under the authority of the local collector. As a consequence, the samples and the decision to issue the samples to a requestor are not transferred to a large organisation but instead remain with the collector, thus allowing autonomous negotiation between collector and requestor, potential co-authorship in publications or compensation for collection and processing costs. Furthermore, it realises a streamlined cost effective network, ensuring tissue visibility and accessibility thereby improving the availability of large amounts of samples of highly specific or rare tumour types as well as providing contact opportunities for collaboration between scientists with cutting edge technology and tissue collectors. With this general purpose in mind, the rules and responsibilities for collectors, requestors and central office were generated.

Europe↗
PubMed2004

Managing under managed community care: the experiences of clients, providers and managers in Ontario's competitive home care sector.

In 1996, a newly elected government in the Province of Ontario, Canada, introduced a managed competition environment into the home care sector through the establishment of a competitive contracting process for home care services. Through 65 in-depth, semi-structured interviews conducted between November 1999 and January 2001, we trace the implementation of this competitive contracting policy within Ontario's newly established managed community care environment and assess the effects of competitive contracting against two sets of goals: (1). quality of care goals that consider continuity of care of paramount importance in the provision of home care; and (2). the managed competition goal of increased efficiency. In assessing the implementation of this policy against these goals, we highlight the conflicts that can arise in pursuing different policy goals in response to different formulations of the policy problem that underpin them. We map stakeholder experiences with the competitive contracting policy onto relevant contracting and managed competition literatures. When measured against the goals of quality of care and efficiency, the findings presented here offer a mixed review of the experiences to date with the competitive contracting process introduced in Ontario's home care sector and suggest improvements for managing future competitive contracting processes.

Attitude of Health Personnel↗
PubMed2004

Bridging the gap between the intensive care unit and general wards-the ICU Liaison Nurse.

The acute care system in our public hospitals has seen an increase in acuity for multiday patients with associated pressure on access to the intensive care unit (ICU) beds for both elective and emergency patients. When an ICU bed has not been available at this hospital, it has resulted in elective surgery being cancelled and/or emergency patients requiring an ICU admission being transferred to other hospitals. Apart from the problems either of these situations can cause to patients and their families, both government and hospital managements expect that access to an ICU (or other) bed will be available for patients in our community who require this level of care. To maximise access to our ICU beds it was necessary to ensure that length of stay (LOS) in ICU was kept to the minimum required for each individual patient and that re-admission rates to ICU for preventable complications were reduced. This paper relates our experience of developing and introducing an advanced practice nursing position (the ICU Liaison Nurse) in 1998, to oversee the transition of patients discharged from ICU to the general wards. Between 1997 and 2002 with the development of the ICU Liaison Nurse (ICU LN) post, medical readmissions to ICU were reduced from 2.3 to 0.5%. It is now 5 years since the position was introduced and the role has evolved over this time so that today the ICU LN not only bridges the gap between ICU and ward-based care, but when necessary can be involved in the care of patients on the ward whose condition has deteriorated to the point where transfer into ICU may be necessary.

Australia↗
PubMed2005

Professional roles and communications in clinical placements: a qualitative study of nursing students' perceptions and some models for practice.

BACKGROUND: Research evidence suggests that clinical placements are important to both the perceptions and outcomes of nurse education. Nevertheless, despite this knowledge, research also indicates that many students receive negative experiences whilst attending these 'remote' settings, sometimes resulting in missed opportunities for learning and negative impressions of potential places of employment. OBJECTIVE: In this context, this study investigates the experiences and perceptions of students relating to their clinical placements and, in particular, their views on professional structuring. Specifically it addresses the roles of, and communications between, the key academics, clinical professionals and institutions responsible for their organization. METHODS: Focus group discussions with students (n=7) and an interview survey of ex-students (n=30) each from two British universities in Southeast England. FINDINGS: The research highlights the diverse experiences that student receive on clinical placements, as well as their own suggestions for improvements. Student informed models of worst, minimum, current and best practice are then presented, as well as a cross-setting evaluation feedback model. These highlight responsibilities and communications across health professionals and educational sites. The models include an emphasis on the roles of ward managers, mentors, link tutors and more generally on shared but clearly delineated institutional responsibility for quality assurance mechanisms. They offer the opportunity to improve educational practice in clinically-based education and concurrently to improve student experiences and outcomes. CONCLUSIONS: Clinical placements are designed to provide practical learning through a 'slice of practice life'. However, it is necessary to maximize this learning experience. Placements certainly need not be the worst slice.

Attitude of Health Personnel↗