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Kropp T, Faeghi S, Lennerts K. Evaluation of patient transport service in hospitals using process mining methods: Patients' perspective. Int J Health Plann Manage 2023; 38:430-456. [PMID: 36374049 DOI: 10.1002/hpm.3593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/16/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Designing healthcare facilities and their processes is a complex task which influences the quality and efficiency of healthcare services. The ongoing demand for healthcare services and cost burdens necessitate the application of analytical methods to enhance the overall service efficiency in hospitals. However, the variability in healthcare processes makes it highly complicated to accomplish this aim. This study addresses the complexity in the patient transport service process at a German hospital, and proposes a method based on process mining to obtain a holistic approach to recognise bottlenecks and main reasons for delays and resulting high costs associated with idle resources. To this aim, the event log data from the patient transport software system is collected and processed to discover the sequences and the timeline of the activities for the different cases of the transport process. The comparison between the actual and planned processes from the data set of the year 2020 shows that, for example, around 36% of the cases were 10 or more minutes delayed. To find delay issues in the process flow and their root causes the data traces of certain routes are intensively assessed. Additionally, the compliance with the predefined Key Performance Indicators concerning travel time and delay thresholds for individual cases was investigated. The efficiency of assignment of the transport requests to the transportation staff are also evaluated which gives useful understanding regarding staffing potential improvements. The research shows that process mining is an efficient method to provide comprehensive knowledge through process models that serve as Interactive Process Indicators and to extract significant transport pathways. It also suggests a more efficient patient transport concept and provides the decision makers with useful managerial insights to come up with efficient patient-centred analysis of transportation services through data from supporting information systems.
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Affiliation(s)
- Tobias Kropp
- Institute for Technology and Management in Construction, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Shiva Faeghi
- Institute for Technology and Management in Construction, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Kunibert Lennerts
- Institute for Technology and Management in Construction, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Hassan NH, Aljunid SM, Nur AM. The development of inpatient cost and nursing service weights in a tertiary hospital in Malaysia. BMC Health Serv Res 2020; 20:945. [PMID: 33054861 PMCID: PMC7556933 DOI: 10.1186/s12913-020-05776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The current healthcare sector consists of diverse services to accommodate the high demands and expectations of the users. Nursing plays a major role in catering to these demands and expectations, but nursing costs and service weights are underestimated. Therefore, this study aimed to estimate the nursing costs and service weights as well as identify the factors that influence these costs.
Methods
A retrospective cross-sectional descriptive study was conducted at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using 85,042 hospital discharges from 2009 to 2012. A casemix costing method using the step-down approach was used to derive the nursing costs and service weights. The cost analysis was performed using the hospital data obtained from five departments of the UKMMC: Finance, Human Resource, Nursing Management, Maintenance and Medical Information. The costing data were trimmed using a low trim point and high trim point (L3H3) method.
Results
The highest nursing cost and service weights for medical cases were from F-4-13-II (bipolar disorders including mania - moderate, RM6,129; 4.9871). The highest nursing cost and service weights for surgical cases were from G-1-11-III (ventricular shunt - major, RM9,694; 7.8880). In obstetrics and gynaecology (O&G), the highest nursing cost and service weights were from O-6-10-III (caesarean section - major, RM2,515; 2.0467). Finally, the highest nursing cost and service weights for paediatric were from P-8-08-II (neonate birthweight > 2499 g with respiratory distress syndrome congenital pneumonia - moderate, RM1,300; 1.0582). Multiple linear regression analysis showed that nursing hours were significantly related to the following factors: length of stay (β = 7.6, p < 0.05), adult (β = − 6.0, p < 0.05), severity level I (β = − 3.2, p < 0.05), severity level III (β = 7.3, p < 0.05), male gender (β = − 4.2, p < 0.05), and the elderly (β = − 0.5, p < 0.05).
Conclusions
The results showed that nursing cost and service weights were higher in surgical cases compared to other disciplines such as medical, O&G and paediatric. This is possible as there are significant differences in the nursing activities and work processes between wards and specialities.
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Sarabia M, Young N, Canavan K, Edginton T, Demiris Y, Vizcaychipi MP. Assistive Robotic Technology to Combat Social Isolation in Acute Hospital Settings. Int J Soc Robot 2018. [DOI: 10.1007/s12369-017-0421-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Utilizing a Human Factors Nursing Worksystem Improvement Framework to Increase Nurses’ Time at the Bedside and Enhance Safety. ACTA ACUST UNITED AC 2017; 47:94-100. [DOI: 10.1097/nna.0000000000000446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Copeland D, Chambers M. Effects of Unit Design on Acute Care Nurses' Walking Distances, Energy Expenditure, and Job Satisfaction: A Pre-Post Relocation Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 10:22-36. [PMID: 27815528 DOI: 10.1177/1937586716673831] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to determine what differences occurred in steps taken and energy expenditure among acute care nurses when their work environment moved from a hospital with centralized nurses' stations to a hospital with decentralized nurses' stations. Additional goals were to determine design features nurses perceived as contributing to or deterring from their work activities and what changes occurred in reported job satisfaction. Since design features can also affect patient outcomes, patient falls were monitored. BACKGROUND The construction of a replacement facility for a 224-bed Level 1 trauma center provided the opportunity to compare the effects of centralized versus decentralized nurses' stations on nurses' experiences of their work environments. METHOD A pre-post quasi-experimental design was used. RN participants completed an open-ended questionnaire and recorded pedometer data at the end of each shift, working for 3-month pre-relocation and for 3-month post-relocation. Nine months passed between the move and post-relocation data collection. RESULTS There were significant reductions in nurses' energy expenditure ( p < .001) and steps taken ( p = .041) post-relocation. Overall, nurses' job satisfaction was high and improved post-relocation, and patient falls decreased by 55%. CONCLUSIONS Post-relocation, a number of the dissatisfiers associated with the physical environment were eliminated, and nurses identified more satisfiers (in general and related to the physical environment). Patients are safer post-relocation as indicated by a decrease in falls. This decrease is even more noteworthy when considering that the numbers of patient beds on each unit is higher post-relocation.
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Affiliation(s)
- Darcy Copeland
- 1 St. Anthony Hospital, Lakewood, CO, USA.,2 University of Northern Colorado, Greeley, CO, USA
| | - Misty Chambers
- 3 Earl Swensson Associates Inc. (ESa), Nashville, TN, USA
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Abstract
This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership.
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Affiliation(s)
- Robin Lea Steaban
- Vanderbilt University Hospital and Adult Clinics, Vanderbilt University Medical Center, Nashville, Tennessee
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Petkovšek-Gregorin R, Skela-Savič B. Nurses' perceptions and attitudes towards documentation in nursing. OBZORNIK ZDRAVSTVENE NEGE 2015. [DOI: 10.14528/snr.2015.49.2.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Nursing documentation is essential for ensuring a safe, high-quality and continuous nursing care and research work. By means of documentation nurses communicate with each other, other members of the healthcare team and other care providers. The aim of the present research was to investigate nurses' opinions about the importance of nursing documentation. Methods: For the purposes of the study, a quantitative non-experimental research design was employed. A quota sampling included the nursing employees in ten Slovenian hospitals. The survey was composed of closed-ended questions. The data were collected from June 1, 2012 to March 31, 2013. The response rate was 44.95 %. A total of 592 respondents participated in the research, 47.3 % with secondary education and 52.7 % with completed undergraduate study programme. Chrombach's coefficient alpha was 0.898. Descriptive statistics, Kolmogorov-Smirnov test, Spearman's correlation coefficient, and Mann-Whitney U test were used. Results: Nurses with at least college degree attributed more importance to documentation compared to those with secondary education (p = 0.001). Statistically significant correlation was not established (p = 0.98). However, a negative correlation was identified between the time used for documentation and positive attitude towards documentation (p = 0.04). Discussion and conclusion: Nurses perceive documentation as an important part of their work. They believe that documentation enhances transparency, quality and continuity of care, and patient safety. It would be necessary to identify the differences in practices and perceptions of handovers between nurses and other healthcare providers.
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Armstrong SJ, Rispel LC, Penn-Kekana L. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox? Glob Health Action 2015; 8:26243. [PMID: 25971397 PMCID: PMC4430688 DOI: 10.3402/gha.v8.26243] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/23/2014] [Accepted: 01/13/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. OBJECTIVE This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. METHODS During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. RESULTS The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers' recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. CONCLUSION The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care.
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Affiliation(s)
- Susan J Armstrong
- Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
| | - Laetitia C Rispel
- Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Loveday Penn-Kekana
- Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Blay N, Duffield CM, Gallagher R, Roche M. A systematic review of time studies to assess the impact of patient transfers on nurse workload. Int J Nurs Pract 2014; 20:662-73. [DOI: 10.1111/ijn.12290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Nicole Blay
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
| | - Christine M Duffield
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
| | - Robyn Gallagher
- Chronic & Complex CareFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
| | - Michael Roche
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology, Sydney Sydney New South Wales Australia
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Expanding Potential of Radiofrequency Nurse Call Systems to Measure Nursing Time in Patient Rooms. J Nurs Adm 2013; 43:302-7. [DOI: 10.1097/nna.0b013e31828eebe1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Muto H, Tani Y, Suzuki S, Yokooka Y, Abe T, Sase Y, Terashita T, Ogasawara K. Filmless versus film-based systems in radiographic examination costs: an activity-based costing method. BMC Health Serv Res 2011; 11:246. [PMID: 21961846 PMCID: PMC3205032 DOI: 10.1186/1472-6963-11-246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 09/30/2011] [Indexed: 11/23/2022] Open
Abstract
Background Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. Methods We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. Results The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. Conclusions The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.
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Affiliation(s)
- Hiroshi Muto
- Graduate School of Health Sciences, Hokkaido University, N12W5, Kita-ku, Sapporo 060-0812, Japan
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Use of clinical simulation centers in health professions schools for patient-centered research. Simul Healthc 2011; 5:295-302. [PMID: 21330812 DOI: 10.1097/sih.0b013e3181e91067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Professional practice assessment research performed in clinical simulation centers is a research method that also creates opportunity for multidisciplinary investigator collaboration. METHODS Nursing and pharmacy school clinical simulation laboratories at the University of Utah were used to conduct time-and-motion (TM) studies of medication dispensing and administration. Time data were then used to determine personnel and supply costs associated with different medication dosage forms and delivery methods. A case study from a completed research project describes the use of TM and activity-based costing analyses to assess medication preparation and administration time and cost differences related to three proton pump inhibitor dosage forms. Standardized doses were prepared by pharmacists or technicians and subsequently administered by nurses to a mannequin in the simulation center by seven different administration scenarios. Simulation scenarios were developed in a manner that held the independent variables constant, so that time and cost differences between dosage forms and administrations methods could be quantified. RESULTS A detailed example of one approach to use of simulation centers for TM studies and activity-based costing analyses is provided. The advantages of isolating processes of interest from the day-to-day complexity of patient care are shown. Results illustrate how simulations based on professional school simulation centers may be used to assess health care processes at the microlevel with potential for projection to the macrolevel. CONCLUSIONS Studies based on health professional schools simulation centers may offer a novel method of evaluating health care processes at the microlevel.
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Lim JY, Kim MJ, Park CG. Analysis of Cost and Efficiency of a Medical Nursing Unit Using Time-Driven Activity-Based Costing. J Korean Acad Nurs 2011; 41:500-9. [DOI: 10.4040/jkan.2011.41.4.500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ji Young Lim
- Associate Professor, Department of Nursing, Inha University, Incheon, Korea
| | - Mi Ja Kim
- Professor, College of Nursing, University of Illinois at Chicago, Chicago, USA
| | - Chang Gi Park
- Senior Health Economist, College of Nursing, University of Illinois at Chicago, Chicago, USA
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Affiliation(s)
- Mi Young Kim
- Unit Manager, Department of Nursing, Samsung Medical Center, Korea
| | - Sung Ae Park
- Professor, College of Nursing, Seoul National University, Korea
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Jones TL. A holistic framework for nursing time: implications for theory, practice, and research. Nurs Forum 2010; 45:185-96. [PMID: 20690994 DOI: 10.1111/j.1744-6198.2010.00180.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
TOPIC Nursing time has relevance for those who produce it, those who receive it, and those who must pay for it. Although the term nursing time may be commonly used, a common understanding of the concept within the fields of nursing and healthcare administration is lacking. PURPOSE The purposes of this paper are to explore the concept of nursing time and to identify implications for theory development, clinical and administrative practice, and research. DISCUSSION Both physical and psychological forms of time are viewed as fundamental to our experience of time as social beings. Nursing time has significant intrinsic and instrumental value in nursing and health care. A holistic approach incorporating the physical, psychological, and sociological aspects and dimensions of nursing time is advocated. CONCLUSIONS Multiple strategies to enhance the patient experience of nursing time are warranted and should address how much time nurses spend with patients as well as how they spend that time. Patterns of overlapping and competing time structures for nurses should be identified and evaluated for their effect on physical time available for patient care and the psychological experiences of time by nurses and patients.
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Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting. Comput Inform Nurs 2010; 29:455-60. [PMID: 21084972 DOI: 10.1097/ncn.0b013e3181fcbe55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.
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Near K, Westley C. Forming a Solid Foundation for Patient Education Through Collaboration. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2010. [DOI: 10.1080/15398281003781030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
TOPIC Economic theory is used to describe and explain decision making in the context of scarce resources. PURPOSE This paper presents two applications of economic theory to the delivery of nursing services in acute care hospitals and evaluates its usefulness in guiding nursing administration research. SOURCES OF INFORMATION The description of economic theory and the proposed applications for nursing are based on current nursing, healthcare, and economic literature. Evaluation of the potential usefulness of economic theory in guiding nursing administration research is based on the criteria of significance and testability as described by Fawcett and Downs. CONCLUSIONS While economic theory can be very useful in explaining how decisions about nursing time allocation and nursing care production are made, it will not address the issue of how they should be made. Normative theories and ethical frameworks also must be incorporated in the decision-making process around these issues. Economic theory and nursing administration are a good fit when balanced with the values and goals of nursing.
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Abstract
The authors review the literature and describe the potential impact of electronic medical records on nursing efficiency, as measured by a reduction in the amount of time nurses spend on activities that are not part of direct patient care. They also identify factors leading to success or failure in achieving electronic medical record-enabled nursing efficiency and illustrate their impact using a case study.
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Pappas SH. Profits, payers, and patients: responding to changes. Nurs Manag (Harrow) 2009; 40:31-36. [PMID: 19346922 DOI: 10.1097/01.numa.0000349687.08918.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Sharon H Pappas
- Centura Health and Porter Adventist Hospital, Denver, Colo., USA
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