Model for a nursing center: spanning boundaries

The article provides an example of spanning organizational and professional boundaries to improve care in a medically underserved community through the development of a nursing center. Descriptions of the practice and organizational models demonstrate how each was tailored to the specific community. Using Andersen's behavioral model of families' use of health services and objectives for the year 2000, the impact on access to care and population outcomes are evaluated.

How wide is the gap in defining quality care? Comparison of patient and nurse perceptions of important aspects of patient care

OBJECTIVES

The authors determine the importance that patients, nurses, and nurse managers place on aspects of care and measure nurses' care values based on their perceptions of their patients and nurse manager care values and their desire to meet these care expectations.

BACKGROUND

The literature has documented gaps in how nurses and patients define quality and value specific care aspects, but little is known about the situation in the current continuous quality improvement and patient-centered care environment, which emphasizes a customer focus. Misunderstanding patients' values and expectations may impede service improvement. Information about any existing gaps could help managers begin to devise patient satisfaction improvement strategies.

METHOD

Two thousand fifty-one medical-surgical patients, 1264 staff members, and 97 nurse managers from 17 randomly selected hospitals participated in study activities related to selected aspects of patient care. Trained interviewers surveyed patients by telephone within 26 days of discharge using a pretested instrument. Staff members and managers completed a coordinated written tool. Descriptive and correlational statistics were used in individual and unit-level analyses.

RESULTS

Staff members perceive correctly that patients value differently various aspects of care but do not agree with their managers on patients' value of aspects of care. Unit staff members' and managers' beliefs regarding patients' care values did not match those of their patients (-14 to 0.11 and -0.01 to 0.06 zero order correlations, respectively).

CONCLUSIONS

A unit's errors in defining patients' values may be self-reinforcing. Strategies to reorient personnel, including adoption of those suggested by the diffusion of innovation literature, may help bridge the gap and change practice.

2,000 patients relate their hospital experiences

This paper uses the reports of more than 2,000 adult medical/surgical patients drawn from 17 randomly selected hospitals within a midwestern major metropolitan area to (1) describe the differences between patients' reports and ratings of car, (2) determine the influence of service failures on patients' recommendations of a hospital to family and friends and (3) suggest constructive managerial responses to current patient satisfaction monitoring strategies.

An analysis of posthospitalization telephone survey data

As part of a study of patient-centered care outcomes that requires the ability to be interviewed by telephone after hospitalization, 4,600 adult patients on 118 medical-surgical units in 17 midwestern hospitals selected by stratified random sampling were identified as potential subjects. This article describes response-rate differences and reasons for nonparticipation by gender, age, ethnicity, and race. Issues related to understanding and reporting response rates, reducing losses due to ineligibility, dealing with refusals, and tailoring survey approaches to special populations are discussed.

Overemphasized use of GPA for admission decisions

When nursing schools have too many applicants for the number of students they can take, many use the cumulative Grade Point Average (GPA) as an important factor in the selection process. However, this practice continues to exclude students, many from minorities, which need to be included in preparing nurses to care for all populations. These authors describe how to use GPA only as an initial preliminary screening tool to determine qualified applicants, but not as a factor in the final decision in selecting students.

The clinical diagnosis of myelopathy

Myelopathy is a complex diagnostic problem with many possible causes. Diagnosis rests on recognition of a constellation of symptoms consistent with central nervous system pathology involving trunk, arms, and legs and, in general, sparing the head. Symptoms of cerebral and neuromuscular disease may mimic myelopathy and require brain imaging or electromyography. Pain, most commonly over the site of the lesion, is one of the cardinal complaints of patients with spinal cord disease. Complaints of motor abnormalities caused by myelopathy may include sudden weakness and paralysis, clumsiness, fatigability; sensory complaints such as paresthesias, numbness, deadness, dysesthesias, and bladder symptoms are also characteristic. General examination may point to systemic disease associated with myelopathy. Neurological examination excludes cerebral disease. Motor and sensory examination may define the level of the lesion. Physical examination localizes not only the level of the spinal cord lesion but the anatomic distribution of the lesion within a given level. When tumor or paraspinal infection are diagnostic possibilities, emergent imaging of the spine is required.

The clinical diagnosis of lumbar radiculopathy

Lumbar radiculopathy may be caused by, or confused with, many different conditions. The nature of the patient's pain--its quality, intensity, location, and profile over time--is an important guide in the evaluation. A careful but directed physical examination is necessary for the clinical evaluation of patients with lumbar spine disease. Evaluation involves inspection of the back and limbs, palpation, and observation of the patient. A careful neurological evaluation, examination of strength, deep tendon reflexes, sensation, and muscular function is necessary. Electromyography is often useful. The most commonly involved nerve roots are L3, L4, L5, and S1. Lesions of each produce distinct symptoms, and other conditions can mimic the radiculopathies. Specific investigation is necessary for an accurate diagnosis.

Hemicrania continua and symptomatic medication overuse

Hemicrania continua (HC) is a rare, strictly unilateral, nonparoxysmal headache disorder characterized by its absolute responsiveness to indomethacin. The pain is usually moderate in intensity and frequently associated with a superimposed "jabs and jolts" headache. We report two cases of HC which presented as chronic daily headache (CDH) with abortive medication overuse. CDH can be due to transformed migraine (TM), new daily persistent headache (NDPH), chronic tension-type headache, and HC. All can be unilateral, and all can be associated with medication overuse. Our two cases meet the criteria for HC based on indomethacin responsiveness. One meets the criteria for TM, the other NDPH. Is HC a distinct disorder, or a subset of these other disorders? CDH with medication overuse includes in its differential diagnosis HC.

Decision making. Stability of clinical decisions

Clinical decisions of 101 medical-surgical nurses were examined for stability. Results indicate that slightly more than 50% of the subjects made stable clinical decisions or decisions not likely to be reversed with minor changes in the clinical data. The findings also reveal that stability was related to hospital setting and country in which the nurses received their education. The authors provide possible explanations for these observations, and recommendations for nursing education and practice.

Transcranial Doppler: technique and application to headache

This article reviews the technique and physics relevant to a functional understanding of transcranial doppler. The frequently contradictory findings in migraine are reviewed. Several studies suggest increased flow velocities are common in the interictal period. There are disparate findings between studies of the ictal period. In cluster headache, there appear to be more easily reproduced changes between and during cluster attacks.

The effect of education on the practice of nursing

This study examines the influence of investments in education on the nature of activities performed on the job. Specifically, attention is focused on whether registered nurses (RNs) with a baccalaureate degree differ from graduates of other programs entailing less schooling in the frequency with which they perform various nursing functions. Results of an ordered probit model using data from the 1986 Biennial Survey of Illinois RNs show that baccalaureate nurses perform high skill functions more often, indicating that education does influence the nature of work activities. Combined with the finding in previous studies that baccalaureate nurses earn significantly higher wages, these results suggest that the labor market differentiates among nurses by education, raising questions about the need to change current licensure laws on informational grounds.

Should continuing education be public policy?

A survey of Illinois registered nurses reveals a striking relationship between employment setting and participation in continuing education programs. It suggests that public policy mandating CE participation may not be the best way to increase such participation among those nurses least inclined to do so.

Baccalaureate Entry Into Practice: An Example of Political Innovation and Diffusion

Activity within several states over the past two decades to require a baccalaureate nursing degree as the minimum educational preparation for licensure as a registered professional nurse is reviewed as an example of policy innovation and diffusion. Sufficient ratio of baccalaureate degree to associate degree programs and political party turnover in the governor's office have frequently accompanied private and public policy action on BS entry.

The relationship between task complexity and decision-making consistency

The purpose of this study was to examine the relationship between task complexity and decision-making consistency using a normative decision model. The Decision Analytic Questionnaire (DAQ), an instrument designed to measure nurses' decision making under increasingly uncertain and complex conditions, was administered to a stratified random sample of 101 paid volunteer medical-surgical nurses drawn from three public teaching hospitals. Probit analysis was used to construct a profile of the decision maker whose decisions coincided with those of the model. Results indicated that nurses made clinical decisions that coincided with those recommended by a normative decision model but that agreement diminished as task complexity increased (p less than .005). The results also indicated that consistency was task specific, that predictive variables were a function of decision task and that more predictor variables were needed to explain consistency as task complexity increased.

Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study

We reviewed CTs from 47 patients with 48 spontaneous, supratentorial brain hemorrhages to determine the effect of ventricular blood on outcome. We correlated volumetric analysis of the parenchymal (P) and ventricular (V) blood, as well as other clinical and CT features, with clinical outcome in a statistical analysis. Hemorrhages were located in putamen 20/48 (42%), thalamus 13/48 (27%), lobar 9/48 (19%), caudate 3/48 (6%), and miscellaneous locations 3/48 (6%). Outcome in putaminal hemorrhages was highly correlated with the total (P + V) and P blood volumes, whereas the V blood was less important. For thalamic hemorrhages, outcome correlated more highly with the V and P + V volumes than with the P portion. Outcome for all hemorrhages was significantly correlated, in descending order of importance, with the severity of the initial neurologic deficit, P + V blood, hydrocephalus, the number of ventricles containing blood, P, V, and blood in the 4th ventricle. In general patients with more than 20 cc of V blood did poorly. Although hydrocephalus was associated with poor outcome, ventricular drainage did not benefit 8 of 9 patients.

Metamorphopsia and palinopsia. Association with periodic lateralized epileptiform discharges in a patient with malignant astrocytoma

A patient with a right parietal glioma developed palinopsia and various forms of metamorphopsia that were temporally related to the electrographic presence of periodic lateralized epileptiform discharges. These symptoms occurred in an alert woman with normal visual fields. The literature shows that epileptic events can produce these symptoms. We believe that continuous repetitive electrical stimulation caused our patient's unusual symptoms by altering the association pathways through which visual data are experienced. To our knowledge, the association between periodic lateralized epileptiform discharges and metamorphopsia or palinopsia has heretofore not been reported.

Taking advantage of the older age profile of today's registered nurses

Our country's population is aging. It shouldn't be a surprise that the nurse population is growing grayer. What should that mean to the employer who is faced with wooing the older professional? Young makes us aware of our youth-oriented employment policies and their flaws for our own demographic population.

Targeting recruitment efforts for increased retention

Recruitment efforts can be targeted towards Registered Nurses demonstrating specific sociometric, education, and practice variables. The authors describe the significant differences found in the comparative analysis within three sets of variables among two groups of hospital-employed Registered Nurses who reside in the suburbs of Chicago. These data can direct nursing administrators in strategic recruitment and retention marketing plans.