Strategic adaptations to PPS by rural hospitals: implications for theory and research

Medicare's Prospective Payment System (PPS) has introduced a new environment in which hospitals must either alter their strategies for delivering services or face closure. This is a challenge for rural hospitals that often lack the resources and supportive economic climate of their urban counterparts. Few guidelines are available to assist rural hospitals in responding organizationally to PPS-induced constraints. This article examines the plight of rural hospitals from the perspective of strategic adaptation. A conceptual framework is proposed for studying strategic adaptations to PPS by rural hospitals. The implications for developing a sound research methodology are also discussed. On the basis of this research agenda, it may be possible to clarify how rural hospitals should adapt to PPS (and similar) constraints now, and in the future.

Risk-Taking Propensity of Nurses: ADN and BSN

Nursing literature indicates that skills in decision making are inherently important to the modern nurse. The literature also reports a controversy between the associate degree nurse (ADN) and the bachelor degree nurse (BSN). This conflict relates to educational level and experience in terms of leadership and decision-making skills. All decisions involve risk. Therefore decisions in nursing should be influenced by the risk-taking propensity of the individual nurse. The literature shows a linkage between risk-taking propensity and both training and experience. The major purpose of the study was to attempt to correlate risk-taking propensity of nurses by level of education and experience. The study investigated whether differences exist between risk-taking propensity of recently graduated ADNs and BSNs without experience. In addition, the study attempted to determine any differences in risk-taking propensity of ADNs and BSNs with practical experience. The results were analyzed in terms of decision-making competency.

Concepts in health promotion: the notion of relativism

'Health promotion' is a new and powerful concept. By some professionals in the field as well as by actors in the policy making spheres, though, the notion may be received with considerable scepticism. We have attributed this scepticism, as well as barriers to include notions of health promotion in day-to-day work, to a lack of knowledge of essential concepts in the health promotion context. In this article we first explore the quintessential nature of 'health' (a capacity of people, rather than an end product of medical care) before we set out to analyze some crucial components of health promotion: integral-ness, intersectorality, holism, and ecology. Integral intervention mixes appear to have synergetic, and therefore cost-effective, results. An intersectoral approach will be necessary to address all determinants of health in an adequate way. Alas, neither integral, nor intersectoral health programs have been documented in depth. The notions of holism and ecology seem to suffer from obscurantism and esoteric elitism, though commendable in their scope. Here, we introduce 'relativism' to combine various valuable approaches into one more comprehensive scheme. Moreover, a 'relativist' approach to health promotion might induce better and more fruitful cooperation among professions. Finally, some research gaps have been identified. Policy development studies remain to have top priority in development of health promotion. Better documentation of efforts in this field will be of crucial importance. Further development of, and research on how to apply relativist approaches may be recommended. Cooperation, and opening up a dialogue between different professions and actors is of great importance in this field.