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Results for “Implementation challenges”

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At least 1,081 records · Page 60Linked to original sources

PubMed1998

Stress and job satisfaction among social workers, community nurses and community psychiatric nurses: implications for the care management model.

The introduction in April 1993 of new arrangements for assessment and care management following the NHS and Community Care Act 1990 (Department of Health 1990a) heralded a period of major transition for front-line workers in the health and social services. Policy expectations for the development of the purchaser/provider split and the 'new managerialism' have posed unprecedented ideological, organizational and professional challenges. Two years after the full implementation of the reforms a postal survey of the experiences of care managers about policy and practice changes was undertaken in Wales. This paper focuses on the stresses and satisfactions of care management practice among three distinct groups of front-line workers: social workers, community nurses and community psychiatric nurses. The results of multiple regression analyses, corroborated by qualitative data, implicate an increased workload in general and administrative work in particular, combined with reduced opportunities for client contact, as the main sources of stress. Being able to control or shape those factors impinging on the experience of stress and job satisfaction appears to lie at the heart of the dilemma. Practice and policy implications are considered.

Journal Article↗

PubMed2001

Pain management in the culture of critical care.

Pain of critically ill patients is undertreated. Undertreatment of pain may be related, in part, to the culture of critical care practice, where nurses are challenged to meet competing patient demands. Implementation of appropriate pain management strategies is within the critical care nurse's scope of practice and must be a priority when delivering patient care. Although the multidisciplinary team can make the best holistic pain management plan, nurses have extensive independence and latitude in administration of pharmacologic and nonpharmacologic interventions. It is, in fact, "primarily the nurses' responsibility to administer the proper drug and dose at the proper time". Fostering a culture within critical care units that promotes optimal pain management is influenced by unit leadership, the values held by the staff, nurse competency, and an effective quality program that includes process and outcome indicators of pain management.

Humans↗

PubMed2000

Translating knowledge into good practice.

Nurses should value knowledge gained by experience, and pass on such knowledge to new colleagues. Collaboration between nurses and academics is a beneficial method of sharing clinical and academic viewpoints. Reflective groups and journal clubs can help to develop evidence-based practice. Implementing knowledge in practice is a challenge and can be very rewarding for practitioners, as well as improving patient care.

Diffusion of Innovation↗

PubMed2002

Impact of formulary restrictions on the cost-effectiveness of antidepressant treatment.

Newer antidepressants are associated with higher costs of treatment of anxiety and depression. Managed care organizations are challenged to control treatment costs by implementing restricted formularies based on price and perceived medical value. Despite unfavorable side effects of efficacious tricyclic antidepressants, the low acquisition cost rationalizes the inclusion of this older class of agents on a formulary. On the other hand, cost-containment approaches have been taken toward more expensive drug classes (e.g., selective serotonin reuptake inhibitors) despite a superior safety profile of these drug classes over tricyclics. There is compelling evidence that dual reuptake inhibitors (e.g., venlafaxine extended-release), which have acquisition costs similar to serotonin reuptake inhibitors, have a broad spectrum of efficacy and thus added value, contributing to the cost-effectiveness of including this agent in the managed care formulary. Assessment of overall cost-effectiveness should not be limited by acquisition costs but should take total healthcare costs into consideration.

Antidepressive Agents↗

PubMedDate not supplied

Matching needs and services: an assessment tool for community-based service systems.

This article presents results from an outcomes-based needs assessment in an urban service district, using case record data to profile service needs in different communities. The methodology emphasizes consistent collection of data from actual case records and explicitly includes line staff and clients in the planning process. Such reviews could benefit a variety of community-based child welfare, health, and education systems, although implementing identified service strategies can be challenging.

Child↗

PubMed2003

[Respiratory viruses: epidemiologic features, clinical impact, and management].

Respiratory viral infections are the most frequent cause for morbidity in humans. Among the different etiological agents, influenza virus causes a disproportionate fraction of morbidity and mortality among the elderly and patients with chronic conditions, who have been traditionally the target of the bulk of preventive measures. Recent epidemiological studies though have demonstrated an important role for influenza viruses to cause morbidity among infants. Conversely, Respiratory Syncytial Virus appears also capable to cause substantial morbidity in adults. Influenza prevention and treatment requires the integrated use of vaccines and of antivirals, including the new neuraminidase inhibitors, either as chemoprophylactic or as chemotherapeutic agents. The implementation of current guidelines is a challenge for all the health care workers involved, even though their cost effectiveness is well demonstrated. In addition, considering the recent epidemiological data, should these guidelines be amended to include young children in groups to be vaccinated?

Adolescent↗

PubMedDate not supplied

Evidence-based practice strategies for cardiovascular care.

Evidence-based practice (EBP) is a problem-solving approach utilizing the best available information to support clinical decisions. The cardiovascular literature sufficiently supports the adoption of EBP to reduce practice variations and improve patient outcomes. However, the ability to appraise evidence and determine the best ways to implement evidence into practice remains a challenge for most clinicians and administrators. Our discussion assesses the quality of evidence and the benefits of evidence-based approaches to care, but also frames the distinctions among research-based, evidence-based, and best practice. Organizational infrastructure is key to developing EBP approaches and sustaining high quality of care.

Cardiovascular Diseases↗

PubMed2004

The HIPAA Security Rule: implications for biomedical devices.

The HIPAA Security Rule, with which hospitals must become compliant by April 2005, is broad in scope. Some aspect of this rule will affect virtually every function and department within a healthcare organization. The functions and departments that deal with biomedical technologies face special challenges due to the great diversity of technologies, the variety of data maintained and transmitted, and the risks associated with compromises to data security--combined with the presence of older technology and the absence of integrated expertise. It is essential that hospitals recognize this challenge and initiate steps now to implement appropriate information security management.

Computer Security↗

PubMed2005

Virtual colonoscopy for primary screening. The future is now.

Virtual colonoscopy (VC) is a minimally invasive tool that utilizes modern CT technology for colorectal evaluation. Since its inception in 1994, VC has continued to rapidly evolve and improve as a diagnostic screening tool. Early success using primary two-dimensional (2D) detection in polyp-rich cohorts was followed by disappointing results in low prevalence populations. Subsequent introduction of the three-dimensional (3D) endoluminal display for primary polyp detection and oral contrast tagging has transformed VC into an effective primary screening tool. This state-of-the-art VC technique has already proven to be a viable enterprise when combined with existing optical colonoscopy practice. More widespread implementation of VC screening faces multiple challenges, but these are all greatly overshadowed by the immediate need for increased participation in effective colorectal screening. Given its relatively noninvasive nature and the wide availability of CT, VC holds significant potential for addressing a very important yet preventable public health concern. This review will cover current VC technique, compare the existing multi-center VC trials, discuss issues related to primary VC screening, and briefly update the progress of our VC screening program.

Algorithms↗

PubMed2006

Teaching undergraduate nursing students critical thinking: An innovative informatics strategy.

Simulated e-Health Delivery System (SEEDS) uses a clinical information system (CIS) to teach students how to process data from virtual patient case studies and work with information technology. SEEDS was developed in response to the Institute of Medicine recommendation that students be taught about information systems in order to improve quality patient care and reduce errors. Curriculum implications, implementation of the system, and technology challenges are discussed.

Curriculum↗

PubMedDate not supplied

The remedial evaluation instrument. A new approach.

This article proposes a different approach to address a reality of the nursing world: that of the Registered Nurse displaying cumulative technical performance deficiencies. This situation, with its accrued practical, intellectual, moral and emotional costs, deserves closer examination and careful reflection. To rehabilitate or to dismiss--two dissenting viewpoints implying ambiguity and distress. The dramatic universal nursing shortage tempts one to override or suppress this problem as does human reluctance to make judgements regarding dismissal. However, the importance of maintaining performance standards is crucial to the well-being of our ultimate consumer--the patient. The authors wish to explore issues surrounding, and the implementation of, one instrument designed to challenge the use of a conventional Employee Performance Appraisal Evaluation. The Remedial Evaluation Instrument (R.E.I.) as proposed in this article, may aid in resolving the problem of substandard employee performance.

Clinical Competence↗

PubMed1988

Teenage pregnancy: issues, interventions, and direction.

The positive health trends and overall improvement in health status among the US population cause health professionals, human service providers, educators, and policy makers to be encouraged about the fitness of our nation. When taking a closer look at these trends and related changes, however, a dilemma exists among a portion of our population that cannot be dismissed. While the health status of the US population as a whole has steadily improved over the past decades, such progress has not been sustained for adolescents. In fact, adolescence (15 to 21 years of age) is the only age group in which mortality rates have increased over the past decade.One of the principal threats to adolescent health is unwanted pregnancy. More than one million teenage pregnancies occur each year in the United States, 75 percent of which are unintended. Teenage pregnancy is a multifaceted problem that requires multifaceted intervention. It is not just the pregnant teenager's problem either, but may involve up to three generations of family members and a host of other significant relationships. The impact and cost to society can become staggering.If such a great proportion of these pregnancies are unintended, what steps can be taken to offer acceptable and accessible alternatives to adolescents? An assessment of the magnitude of this problem, its impact on the family and society, and the measures implemented to date reveal a major challenge facing our policy makers, health and human service providers, and concerned citizenry.

Adolescent↗

PubMed1993

Reallocating power.

Nursing management throughout the country must accept the realization that the "profession" of nursing is at a crossroads. Nursing must either abandon its claim as a profession or revise nursing's support structures in order to provide a professional practice environment. Those who accept nursing as a profession understand the responsibility and authority of the profession. These values involve the desire to assume accountability, articulate the practice of nursing and nursing competence, and define the quality of care provided. As the majority of nurses continue to practice within the hospital setting, the challenge facing nursing management is the implementation of professional governance practices.

Decision Making, Organizational↗

PubMed1993

Velopharyngeal insufficiency and secondary palatal management. A new look at an old problem.

The main objective of primary palatoplasty is to achieve adequate velopharyngeal (VP) function and normal oral-nasal resonance. Many children, however, who undergo cleft palate repair fail to develop normal VP function. Symptoms of velopharyngeal insufficiency (VPI), such as hypernasality and audible nasal air emission, may have a variety of causes, which underscores the need for comprehensive evaluation. This article focuses on the problem of VPI and emphasizes the need for differential diagnosis at the most critical step in management planning. The challenge of the future is to implement the team approach, integrating the expertise of speech scientists and plastic surgeons, so that differential diagnosis can and will lead to differential management.

Bone Lengthening↗

PubMedDate not supplied

Broadening the scope of nursing practice: federal programs for children.

Various social programs are available to support the family unit when a child with special needs enters the health care system. Nurses are challenged to link families with appropriate federal programs. An understanding of selected legislation and the programs designed to implement those laws better enables them to meet that challenge.

Adolescent↗

PubMedDate not supplied

Opportunities and challenges in educating community-responsive physicians.

Medical educators, funders, and policy makers are placing greater emphasis on educating physicians-in-training to provide community-responsive care and to participate in community-focused health-promotion and disease-prevention efforts. The MCP [symbol: see text] Hahnemann School of Medicine requires all first-year students to work in the community on projects involving health education, needs and resource assessment, advocacy, outreach, and other community health skills. The Department of Community and Preventive Medicine at MCP [symbol: see text] Hahnemann directs these required courses, as well as other elective programs that provide students the opportunity to develop community health competencies. This article summarizes key elements of these educational activities and discusses challenges we have encountered developing and implementing these activities and our responses. Finally, we suggest some issues and questions deserving further exploration.

Community Medicine↗

PubMed1997

[Quality promotion in public health research].

One of the common features of the five Public Health Research Centres of Germany lies in quality assurance and quality improvement of their research activities. The institutionalisation of systems of quality improvement of Public Health Research has to be regarded as innovative, hitherto unparalleled, in the German context. The article deals with the demands on quality improvement confronting empirical research, the possibilities of coming to terms with this challenge, and still unresolved problems of implementation. Demands will be outlined in discussing quality criteria and processes of empirical research, paying special attention to differences between qualitative and quantitative designs of inquiry. The concept of quality improvement, developed in the Munich Public Health Research Centre, applies two basic strategies to meet these demands: enhancement of the transparency of the research process, and the training of research staff. Instruments for quality improvement are introduced: some of them may be applied by the research team itself (such as study protocol, research diary, team discussion) some of them have to be realised by external staff, especially responsible for the process of quality improvement, in cooperation with the research team (quality circles, training, compilation of written material). In conclusion, the implementation of instruments of this kind is discussed, concentrating on the problematic cooperation between research team and external staff.

Forecasting↗

PubMed1996

Evaluation of a national health promotion program in South Australia.

This paper reports the findings of the evaluation of the South Australian component of the National Better Health Program. The evaluation used analysis of focus-group interviews and key documents to assess the value of the state program. The evaluation demonstrated that for a relatively small investment ($2.4 million was allocated to the project over four years, representing only 0.5 per cent of the annual budget for teaching hospitals in South Australia), much can be achieved by harnessing the energy of local communities. The evaluation concluded that more attention should be directed to structural change, with an emphasis on collaboration across sectors, and community participation. Some key issues for the planning and implementation of health promotion were highlighted: the challenge of marrying local initiatives based on community development with national health promotion objectives; the importance of dedicated and assured funding; the need for increased training and support for health promotion workers; and the importance of continuing a focus on equity in the implementation of health promotion. The paper concludes by questioning the value of the current Australian goals, targets and strategies for health, given the findings from this evaluation.

Community Participation↗