Evaluating the service quality of undergraduate nursing education in Taiwan--using quality function deployment

This study applies quality function deployment (QFD) techniques to evaluate the quality of service of undergraduate nursing education in Taiwan from the perspective of nursing students. Survey data from 560 undergraduate nursing students at four Taiwanese universities were subjected to QFD analysis in order to identify the quality characteristics most highly valued by students, the elements of educational service they consider most important and least important, and relationships/discrepancies between student quality requirements and institutional service elements. Results show that students value traditional elements of nursing education - clinical practice and lectures - more highly than recent additions such as computer-aided instruction and multimedia teaching. Results also show that students are looking for quality primarily in the area of faculty characteristics. The implication is that institutions which provide nursing education should not neglect the importance of investing in faculty when they are seeking to upgrade the quality of their programs. Further QFD studies are recommended to evaluate the quality of nursing education from the perspective of preceptors and nurses who help to train students in clinical settings.

We are the experts: people with asthma talk about their medicine information needs

People with chronic illness are being encouraged to become more involved in their care. For this, they need to be well informed about their medicines, and more written medicines information is becoming available. However, there is little data about its effectiveness and impact. This study examined the patient perspective of medicines information through focus groups of people with asthma. Most participants actively sought medicines information from a variety of professional and lay sources. There were some positive experiences but many examples of partial or total information failure. Individualised information was valued and medicine leaflets were generally seen as less helpful than face-to-face advice. Some felt strongly that patients with long experience should be involved in the development of medicine information leaflets. We conclude that medicine information leaflets do not currently meet the needs of users and that people who take medicines should be involved in their development and testing.

Flexible learning for postgraduate nurses: a basis for planning

This paper describes a survey undertaken with postgraduate nursing students in a New Zealand University based School of Nursing in 2002 to establish their access to and use of computers and information technology for study. Whilst there is minimal flexibility and use of technology to support student learning for postgraduate nurses in the University's School of Nursing presently, the University proposes increasing flexibility across all courses. This is in part a response to the increased internationalisation of education and developments in technology affecting programme design, delivery and support that can benefit teachers and students. The findings of this survey form a basis for planning the introduction of flexible learning. Results indicate that not all students have convenient access to technology for study purposes, nor are they at the same level in terms of using technology. The implications of the survey for planning flexible learning, including the need to be explicit about requirements for access to technology and upskilling opportunities are discussed.

A geographic information system simulation model of EMS: reducing ambulance response time

Response time is a very important factor in determining the quality of prehospital EMS. Our objective was to model the response by Israeli ambulances and to offer model-derived strategies for improved deployment of ambulances to reduce response time. Using a geographic information system (GIS), a retrospective review of computerized ambulance call and dispatch logs was performed in two different regional districts, one large and urban and the other rural. All calls that were pinpointed geographically by the GIS were included, and their data were stratified by weekday and by daily shifts. Geographic areas (polygons) of, at most, 8 minutes response time were simulated for each of these subgroups to maximize the timely response of calls. Before using the GIS model, mean response times in the Carmel and Lachish districts were 12.3 and 9.2 minutes, respectively, with 34% and 62% of calls responded within 8 minutes. When ambulances were positioned within the modeled polygons, more than 94% of calls met the 8-minute criterion. The GIS simulation model presented in this study suggests that EMS could be more effective if a dynamic load-responsive ambulance deployment is adopted, potentially resulting in increased survival and cost-effectiveness.

Justice and solidarity in priority setting in health care

During the last decade a "technical" approach has become increasingly influential in health care priority setting. The various country reports illustrate, however; that non-technical considerations cannot be avoided. As they often remain implicit in health care package decisions, this paper aims to make these normative judgements an explicit part of the procedure. More specifically, it aims to integrate different models of distributive justice as well as the principle of solidarity in four different phases of a decision-making procedure, and to identify important moral choices which present themselves. First four important justice models are discussed, then a justification is given for their inclusion in a four-step decision making procedure. This is followed by a discussion of different justice and solidarity problems--with their inherent conceptual difficulties in each of these stages. The paper concludes with a summary of the major moral choices that are to be made in health care package decisions.

Provider perceptions of pharmacy management: lessons from the military health system

OBJECTIVE

The objective of this study was to contrast experiences and opinion of providers in military treatment facilities, where a single formulary is used, with those of community providers where multiple formularies and preferred lists are commonly encountered.

STUDY DESIGN

We conducted cross-sectional surveys.

SETTING

The study was conducted at military and community practices that serve military beneficiaries.

PARTICIPANTS

We studied randomly selected clinicians, stratified by military treatment facility (MTF) size or number of military beneficiaries served. The final samples included 566 eligible MTF and 557 private clinicians, with 69% and 38% response rates, respectively.

OUTCOME MEASURES

We wanted to determine experiences with and opinions of formularies and/or preferred lists and related policies.

RESULTS

Sixty-three percent of military providers were very familiar with formulary content and 60% with nonformulary request procedures; 67% thought their formulary was up-to-date and 84% felt Pharmacy & Therapeutics (P&T) committees were responsive to providers. In contrast, 23% of community providers felt very familiar with (multiple) formulary content and 10% with nonformulary request procedures. Only 15% perceived that formularies were current and 34% thought P&T committees were responsive to providers. Statistically significant differences remained after analysis of potential bias.

CONCLUSIONS

Community providers were less aware and less satisfied with pharmacy benefits management policies than military providers, likely as a result of their daily interactions with multiple, unrelated pharmacy management systems. Addressing the problems expressed by community providers is imperative for pharmacy benefits managers.

Hispanic healthcare disparities: challenging the myth of a monolithic Hispanic population

BACKGROUND

Hispanic Americans are often treated as a monolithic ethnic group with a single pattern of healthcare utilization. However, there could be considerable differences within this population. We examine the association between use of healthcare services and Hispanic Americans'country of ancestry or origin, language of interview, and length of time lived in the United States.

METHODS

Our data come from the Medical Expenditure Panel Survey, a nationally representative survey of healthcare use and expenditures. Descriptive statistics and logistic regression results are presented.

RESULTS

Multivariate models show that Mexicans and Cubans are less likely, and Puerto Ricans more likely, to have any emergency department visits than non-Hispanic whites. Mexicans, Central American/Caribbeans, and South Americans are less likely to have any prescription medications. All Hispanics are less likely to have any ambulatory visits and prescription medications, whereas only those with a Spanish-language interview are less likely to have emergency department visits and inpatient admissions. More recent immigrants are less likely to have any ambulatory care or emergency department visits, whereas all Hispanics born outside the United States are less likely to have any prescription medications.

CONCLUSIONS

The Hispanic population is composed of many different groups with diverse health needs and different barriers to accessing care. Misconceptions of Hispanics as a monolithic population lacking within-group diversity could function as a barrier to efforts aimed at providing appropriate care to Hispanic persons and could be 1 factor contributing to inequalities in the availability, use, and quality of healthcare services in this population.

Bridging the gap: the Virtual Chemotherapy Unit

Due to the complexity of pediatric chemotherapy administration, systems promoting safety must be utilized. Computerized order entry has been proven to reduce errors in the ordering of chemotherapeutic agents. A task force (the Breakthrough Committee) at The Children's Hospital of Philadelphia (CHOP) evaluated systems and identified the need to streamline the chemotherapy admission process from the outpatient clinic to the inpatient unit. In the outpatient setting chemotherapy orders were handwritten, whereas inpatient orders were computerized. Patients due for chemotherapy admissions were unable to start chemotherapy until they were physically admitted to an inpatient bed. In many cases, patients would not start receiving chemotherapy until late in the evening or even overnight. The Breakthrough Committee created the Virtual Chemotherapy Unit (Virtual Unit), which standardizes the ordering and documentation for all chemotherapy admissions. As per its name, the Virtual Unit is not an actual hospital unit but merely a location in the computer system where the patient is admitted prior to having a bed on the inpatient unit. Patients are now able to start chemotherapy infusions in the outpatient setting early in the day, rather than waiting until arrival to the inpatient unit. The nurses in the outpatient clinic are able to document chemotherapy administration online, giving the inpatient staff the ability to view the medications that were given. The Virtual Unit bridges the gap in chemotherapy ordering and documentation by utilizing 1 online episode per patient admission. Oncology nurses at CHOP played a fundamental role in the creation of the Virtual Unit. Nurses identified situations with potential for error in the ordering and administration of chemotherapy. These scenarios were analyzed and used in creating a safer system.

How patient involvement in care is improving service provision

An emphasis on public and service-user involvement runs through the core initiatives of the modernisation agenda as outlined in The NHS Plan (Department of Health, 2000) and related policy documents. This article discusses problems that have prevented the NHS from being responsive to the views of service users and what the implementation of policies can offer in terms of overcoming such problems. In addition, initiatives and other ways of identifying and delivering public or patient needs are considered.

Information needs and the related variables of Japanese family caregivers of terminally ill cancer patients

The present study examined the information needs of family caregivers of terminally ill cancer patients. Data were obtained by a structured interview from 66 Japanese caregivers of cancer patients institutionalized in a palliative care unit. Needs for disease-related information (the disease, treatment and prognosis) and care-related information (the care for the patient and family members) were investigated, and demographic and situational characteristics related to individual information needs were assessed. More than 60% of family caregivers wanted disease-related information, and approximately half of these wanted patient and family care-related information. These information needs had significant correlations with the family caregiver's age and with such patient-dependent situational variables as time since diagnosis, care site before enrolling in a palliative care unit, and presence or absence of other family caregivers. The results may help health care professionals to better inform terminally ill cancer patients and their family caregivers.

An application of health literacy research

Finding methods to improve the delivery of educational materials by the practicing nurse is imperative in the current health care arena. Time, energy, and effectiveness are all aspects that are critical as the health care provider attempts to meet the growing needs of the compromised client. Low functional health literacy is one public health problem that impacts the nurse's ability to effectively provide health instruction in a timely, organized manner. This article presents a pilot research project used to investigate the mastery of educational information by clients in a West Texas area. The research project is used as the foundation for discussion of several interesting facets resulting from the initial research. Ideas are presented as a direction for implementation for practice within the health care community. Low health literacy is a grave challenge, which currently is not understood nor considered by the nurse at the bedside. Practicing health care providers need the opportunity to carefully and specifically investigate the role of health care literacy in producing positive client outcomes.

The perceived needs of Jordanian families of hospitalized, critically ill patients

The purpose of this study was to identify needs of Jordanian families of hospitalized, critically ill patients. The Critical Care Family Needs Inventory was introduced to 158 family members who were visiting their hospitalized, critically ill relatives. The findings revealed that > or = 80% of the family members perceived 16 need statements as important or very important. The participants ranked order needs for assurance, information and proximity the highest and needs for support and comfort the lowest. Specifically, the most important needs of the families were to receive information about the patients, to feel that the hospital personnel care about the patients and to have the information given in understandable terms. Results of this study indicated that Jordanian families had specific and identifiable needs. Providing families of critically ill patients clear, simple and updated information about the patients, and assuring them about the quality of care the patients receive, should be essential components of the critical care nursing delivery system.

Utilization of a Multidisciplinary Team for Inpatient Diabetes Care

Diabetes is often noted as a secondary diagnosis when patients are admitted to the hospital for care. Patients admitted to critical care areas are usually more ill and require aggressive glucose control. Often the education and self-care management skills needed for home management are overlooked until discharge, which can cause an increased length of stay. There is a feeling of frustration among nurses who are unable to adequately meet the needs of these patients and their families. In one community hospital setting, they have designed a model that identifies patient needs on admission and utilizes a multidisciplinary team. Beginning the "discharge" process early in the admission will ensure that a timely discharge with a well-trained patient will occur.

Moving on from ‘patient dependency’ and ‘nursing workload’ to managing risk in critical care

The contribution nurses make to the management of critically ill patients is usually appraised through the use of concepts such as 'patient dependency' or 'nursing workload'. These concepts fail to address the knowledge, skills and experience of nurses and consequently fail to acknowledge the risk presented by critically ill patients. This paper describes the development of a tool that attempts to measure risk and the process of risk management undertaken by nurses who coordinate the shifts and lead the nursing team. The results of this pilot study indicated that the tool was valid, but reliability has not yet been demonstrated. Thus the tool requires further refinement and testing. We chose to publish at this time because we feel the paper offers a new way of examining the contribution of nurses working in critical care.

Globalization impacts the healthcare organization of the 21st century. Demanding new ways to market product lines successfully

Healthcare is, and will continue to be, impacted by unrelenting forces transforming the healthcare system. The Internet (computers and telecommunication) makes it possible for patients to communicate globally on healthcare issues, and they are more educated about wellness, disease prevention, and medical treatments. This age of information also offers telehealth, which continues to alter the doctor-patient relationship, as well as disease management. The world as we know it changes daily. From the drastically changing demographic composition of the social order to rapidly emerging new technologies, the world of healthcare today is more expansive--an important dimension that nurse executives must recognize in order to lead their organizations in a new global marketplace. When historians chronicle the events that impacted the 21st century, they are certain to highlight the world's increasing consciousness of its interdependence. Abundant evidence will be found in literature that speaks to "globalization" when describing cultural, economic, environmental, and political issues. This unprecedented interconnectedness of healthcare across the globe will include nurse executive leadership talents.

Picking up the challenge: developing a methodology to enumerate and assess the needs of the street homeless population

This study represents the first enumeration of the street homeless population in Canada. Past enumeration attempts have been challenged on their significant methodological shortcomings. This enumeration directly addressed the lessons learned from previous attempts, and improvements to the methodology are presented and discussed. In addition, lessons learned and recommendations are discussed for application to future enumerations.