Improving the quality of care of veterans with diabetes. A simulation intervention for psychiatric nurses

The primary objective of this study was to provide and evaluate strategies beneficial in preparing psychiatric nurses to exercise clinical judgment needed for adequate assessment and care of veterans with diabetes. Psychiatric nurses completed a pretest evaluation of their knowledge of care for veterans with diabetes. During the intervention stage, a human patient simulator was used to create an interactive scenario for participants to propose a diagnosis and administer treatment. Clinical judgment attributes were evaluated during the simulation by instructors using a rubric. Participants then completed a posttest evaluation. In addition, data about medical transfer rates for veterans with diabetes were provided 1 month before and 1 month after project implementation. All participants (N=20) demonstrated an increase on posttest scores. Medical emergencies decreased from 55% to 20% after project implementation, indicating improvement in the quality of care of veterans with diabetes.     

Implementing medication algorithms. Role of behavioral health nurses

1. Clinical practice guidelines, also called algorithms, practice standards, protocols, and policies, are systematically refined parameters that guide decision making related to specific clinical disorders. 2. Algorithms and clinical practice guidelines were developed to provide a sequential framework for clinical decision making, improve quality of care, increase patient safety, control costs, and provide standardization of care. 3. While each format used to develop algorithms and clinical practice guidelines has advantages and disadvantages, the evidence-based format, in which an expert panel reviews evidence and designs the guidelines, which are then reviewed by practitioners and organizations in that clinical area, provides the most up-to-date and accurate guidelines. 4. As frontline caregivers in the behavioral health care system, nurses are in an ideal position to monitor patients' adherence and responses to clinical guidelines, including medication algorithms.     

Can Bundled Payment Improve Quality and Efficiency of Care for Patients with Hip Fractures?

The current Medicare reimbursement for hip fractures lacks accountability and promotes cost cutting. A bundled payment system—analogous to the Medicare Acute Care Episodes Demonstration for Orthopedic and Cardiovascular Surgery—may help curtail costs, foster communication among health care providers, and improve their accountability for patient outcomes. In hip fracture care, bundled payment may spur development of multidisciplinary best practice guidelines, quality assessment, and reporting, and result in benchmarking and best practices sharing. However, its implementation may face challenges: the need for quality assessment criteria and risk adjustment methods and possible risks of pushing costs outside of Medicare boundaries.     

Herpes: Coping and Caring—A Total College Health Program

Abstract

This article seeks to assist college health nurses in developing appropriate protocols for patient care. In addition, the authors outline factors influencing protocol content, design, and development and describe steps in creating individualized protocols by practice setting. To provide college health nurses with a basic understanding of protocols, the authors offer definitions and examples of appropriate and inappropriate use, and show how protocols can influence the delivery of patient care. Although protocols may provide college health nurses with directives for managing specific health problems, they require a sophisticated level of judgment and skill in their implementation.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Recruitment & retention. A successful model in forensic psychiatric nursing

1. The recruitment and retention of forensic psychiatric nurses in this highly competitive environment has been identified as a critical issue. 2. In response to the need to expand services, the development, implementation, and evaluation of an innovative model that has demonstrated success in the recruitment and retention of nurses for this highly specialized area of practice are described. 3. The successful recruitment and retention of forensic psychiatric nurses may be facilitated by developing and implementing strategies that integrate the goals and objectives of the organization with the needs of individual nurses.     

Bridging the gap between primary care and mental health

Major depression is a leading cause of disability in the United States and is frequently diagnosed and managed within a primary care setting, with less-than-optimal results. Studies have shown that adequate follow up significantly affects patient outcomes, including mortality; however, primary care providers face many challenges in providing this care within the constraints of a primary care setting. Collaborative care models have been shown to be effective in managing depression, and accordingly, the Translating Initiatives for Depression into Effective Solutions (TIDES) model was selected by the Bay Pines Veterans Affairs Healthcare System to help primary care providers manage depressed patients within the primary care setting. This article describes the implementation of TIDES and identifies a new role for mental health nurses outside of the traditional mental health setting.     

Evidence-based practice in occupational health: description and application of an implementation effectiveness model

Work-related muscuoloskeletal disorders (WMSDs) continue to represent the most costly category of occupational diseases. There is a growing body of literature regarding the causal nature of these injuries and effective intervention strategies. In this context, the consistent utilization of evidence-based practice (EBP) to address these problems can be viewed as one indicator of occupational health effectiveness. However, the routine integration of EBP remains elusive in occupational and physical therapy practice, including the occupational health arena. This article describes an implementation effectiveness model from the field of organizational management and applies it to the implementation of EBP within the occupational health practice arena. As a predictive or evaluative tool regarding implementation success, the model can assist clinic managers and clinicians in developing targeted approaches to EBP initiatives within any health care facility.     

Policy recommendations for rare disease centres of expertise

AimRare diseases are a serious public health concern and are a priority in the EU. This study aims to develop policy recommendations for rare disease centres of expertise (CoEs) in order to improve standards and quality of care.Subject and methodsA modified 3-round Delphi technique was used. Participants included rare diseases patients, carers, patient representatives and healthcare professionals (HCPs) from CoEs in two countries—Denmark and the UK.ResultsThe results suggest the need to make improvements within current CoE environments, access to CoEs and the need for coordination and cooperation of services within and outside CoEs. It is recommended that CoEs are not overly ‘medicalised’, while at the same time they should be established as research facilities. The importance of including patient representatives in CoE performance management was also highlighted. Raising awareness and provision of appropriate training amongst non-specialist HCPs is seen as a priority for early and correct diagnosis and ensuring high quality care. Similarly, provision of targeted information about patients’ illness and care was considered essential along with access to social assistance within CoEs.ConclusionsPolicy recommendations were developed in areas previously recognised as having gaps. Their implementation is expected to strengthen and improve current care provision for rare disease patients. In member states where national plans and strategies are being developed, it is recommended to replicate the methodological approach used in this study as it has proven to be a helpful tool in rare disease centres of expertise policy development.     

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

Another face of health care disparity: stigma of mental illness

In many everyday situations, individuals with mental illness face stigma that leads to discrimination. A growing body of evidence suggests that those with mental illness experience disparities in health care and that their medical needs are often overlooked. The purpose of this article is to increase awareness to this problem. Fictional vignettes in which individuals with mental illness seek medical care are presented, followed by discussion on the role discrimination may play in the level of care these patients received. To help alleviate disparities, nurses are encouraged to advocate and speak out when they suspect discrimination is affecting the quality of care of those with mental illness.     

Developing family-based care: complexities in implementing the UN Guidelines for the Alternative Care of Children

In response to immense challenges facing children in out-of-home care in all parts of the world, there is a growing international trend towards the development of family-based placements for children in out-of-home care, away from large-scale institutions. This development of family-based care within a range of care options is recommended within the international Guidelines for the Alternative Care of Children (the Guidelines), which were welcomed unanimously by the United Nations General Assembly in 2009. This paper offers an overview of these guidelines’ key principles, and considers the complexities that arise in efforts towards their implementation. Drawing on the literature, supported by research that informed Moving forward (the implementation handbook on the Guidelines) and illustrated by practice examples from across global regions, the authors examine three fundamental challenges in States’ efforts to implement the Guidelines’ ‘suitability’ principle, namely: de-institutionalising the care system; financing suitable family-based care and supporting the suitability of kinship care. The paper critically reflects on de-institutionalised systems and practices, and the cross-cultural assumptions about suitable foster and kinship care that emerge in efforts towards de-institutionalisation; it aims to spark new thinking on strategic ways in which alternative care is planned and delivered, to impact on future practice.     

Transnational social workers’ transition into receiving countries: what lessons can be learned from nursing and teaching?

Appropriate interventions for assisting transnational social workers (TSWs), nurses and teachers in their transition into the receiving country are significant for enabling competent and safe professional practice. These professionals form a significant part of the professional workforce of many countries as globalisation and liberal migration policies encourage many to cross borders for professional practice. Engaging in employment overseas, however, is a challenging process for them as it entails relocating to a new country and working in unfamiliar sociocultural and practice contexts. While some form of profession-wide assistance is found in nursing and teaching, social workers rarely receive any such interventions. This article discusses existing support offered to transnational nurses and teachers in English-speaking countries such as the UK, US, New Zealand, Australia and Canada and suggests how a similar approach to social workers can assist their transitioning into the receiving country. It draws on the findings of a thematic review of the literature addressing support for transnational nurses, teachers and social workers. The imperative of interventions to assist transition of TSWs into host countries is explored and the article concludes with recommendations for some intervention strategies and mechanisms.     

Inclusiveness,power sharing and critical enquiry: intercultural programme model for new settlers

Migrants and refugees settling permanently in a new country face significant social, linguistic and cultural challenges. However, they also bring intercultural strengths and skills which, if acknowledged and enhanced, can support successful settlement and inclusion in a pluralistic society. This paper describes the underpinning rationale and salient features of an intercultural settlement programme piloted in New Zealand with a group of recently arrived settlers from refugee backgrounds. The programme was designed to enhance the settlement process for newcomers through the development of critical thinking, problem-solving and intercultural skills. The pedagogical approach was rights-based and incorporated facilitated discussions within an environment of power-sharing, inclusiveness and critical enquiry. This paper discusses the implementation of the programme as well as findings from a preliminary research project which sought to explore the effectiveness and the extent to which the programme achieved its aims. The findings indicate that this approach can constitute good practice in an education programme designed to support interculturalism and successful integration.     

Quality of medical care by central government health scheme--a study

This study reports findings on the time spent by CGHS medical officers per patient in different medical care activities for 2,115 patients, as obtained by time study technique. This study was conducted during the year 1976-77. The average observed time spent by the medical officer per patient was found to be 117.15 seconds per patient. The medical officers elicited only main complaints without asking past and family history in 84.44 per cent of patients and the average time spent on history taking was 42 seconds per patient which also included examination of identify card, recording of name, age and sex of the patients. Physical examinations were conducted in only 23.88 per cent of patients and the time spent per patient was 45.93 seconds. The advice for investigations was imparted in 2.60 per cent of patients, though the facilities for routine laboratory examinations were available in the dispensaries. Advice to the patient regarding dietary instructions and general advice was exclusively given in only 5.20 per cent of cases whereas the family planning/health education advice to the patients was given only in 0.76 per cent of patients. The medical officers are aware of the inadequate quality of medical care provided to the beneficiaries and they felt they should at least spend 6.83 minutes for an old patient and 12.42 minutes for the new patient. Probably they are not able to do so because of long queues in the dispensaries during peak hours. Hence, to improve the overall medical care and provide comprehensive care to the beneficiaries it is suggested that the medical officers can be given certain beneficiary population and made responsible to them.     

Contextualizing Migrants' Strategies of Seeking Medical Care in Russia*

Russia is an important destination for labour migrants from the former Soviet Union republics especially Central Asian low‐income countries: Kyrgyzstan, Tajikistan, and Uzbekistan. The life of migrants from Central Asia is characterized in Russia by scarce resources and social exclusion. Limited access to healthcare is aggravated by the negative attitudes and discrimination that migrants face when visiting state hospitals and clinics. In our study, we aim to describe the medical infrastructure available to migrants in Moscow. We investigate how migrants use formal and informal strategies to overcome the barriers to their receiving medical care in the urban environment. The study is based on the analysis of qualitative interviews with 60 labour migrants from Central Asian countries and 23 caregivers working in Moscow‐based medical facilities such as state hospitals, outpatient clinics, ambulance stations, and private medical centres including the so‐called Kyrgyz clinics.     

Queues and care: how medical residents organize their work in a busy clinic

How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings.     

Effectiveness of a training program for ECT nurses

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.