Chemical synthesis of 15 beta-hydroxytestosterone and its derivatives using a (4-methoxyphenyl)methyl protecting group

This article describes the Community Nursing Organization, a federal health care model designed to provide specific ambulatory and outpatient services to medicare beneficiaries via a nurse managed delivery system under capitated financing. A primary nurse provider, working with the elderly client, family, physician, health care service providers, and community organizations, assesses the need for care and arranges for appropriate services. This nurse must also authorize payment of those services covered by the Community Nursing Organization (CNO). A 3-year demonstration project is currently under way. Findings at 1 year indicate that the system may have a positive effect on client health status.     

Engaging Latinos through the integration of cultural values and motivational interviewing principles.

A rapidly growing Latino population challenges the U.S. mental health system. Despite a high service need, significant disparities in access to care have resulted in patterns of low utilization and frequent dropout. Furthermore, natural ambivalence as individuals access a traditionally underutilized source of support may further compromise the effective therapeutic engagement of Latinos. Thus, practitioners and researchers seek to identify means by which to enhance service delivery for this historically underserved population. Following the demonstrated efficacy of motivational interviewing with highly ambivalent client populations and drawing on the authors' clinical experiences with monolingual Spanish-speaking Latinos in a community mental health setting, this article describes the application of motivational interviewing principles to 3 Latino cultural values and offers clinical practice recommendations to help create a client-centered and culturally congruent therapeutic milieu. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A needle type therapeutic system incorporating laser light and lumin for immunotherapy of cancer growing in deep organs

The dynamic interactions of the client, service provided, and payer are complex relationships in today's health care environment. An advanced practice nurse's abilities to care physically and psychosocially for clients and their families are essential within the case management framework. With a holistic view of clients' health status, the nurse case manager develops and carries out advanced practice functions that help achieve the best outcome for the client through effective interactions with clients, payers, and providers. Those functions, illustrated by the Star Case Management Model, include interpretation, advocacy, and surveillance.     

The effectiveness of inpatient case management. Fact or fiction?

Production processes and service delivery in acute care hospitals can be fragmented. Inpatient case management has the potential to improve both processes and outcomes of hospital care. The author reports on 18 research studies that used inpatient case management as the treatment variable. These outcome studies, using case management, did not provide the evidence needed to address deficiencies in inpatient settings. However, these studies do provide clear direction for nurse administrators and nurse researchers to take concerning the next steps needed to address this critical issue.     

Therapist modification of client expressiveness in client-centered therapy.

Based on evidence that has linked client expressiveness to therapy outcomes and has demonstrated the prognosis of inexpressive clients to be poor, a case of client-centered therapy in which the therapist directly attempted to intervene and increase the expressiveness of an inexpressive client is reported. In interviews with the patient, a male in his mid-twenties suffering from severe depression, subsequent to the intervention, client expressiveness showed a significant increase over baseline, and this increase was maintained without further therapist intervention. Implications for the treatment of the inexpressive client and for revising the traditional view of client-centered practice as nondirective are discussed. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biochemical mechanisms of the toxic effect of oxalates

Australian nursing is undergoing major changes in practice, education and research in a climate of burgeoning health-care costs, and changing priorities and service directions. The government is searching for new ways to deliver services that are appropriate and equitable while focusing on containing costs. These are signs that it is an opportune time for nurses to test new roles, and one suggested way to provide extra cost-effective service is through the use of nurse practitioners. In order to improve the delivery of mental health services, the nurse practitioner specializing in mental health can provide a link between the community and the primary care provided by general practitioners. A proposed model for nurse practitioners in mental health is presented as a means of bridging this gap.     

Initiating a patient service partner program

Rising costs and the need to increase patient satisfaction are driving hospitals to restructure care delivery. At one hospital, housekeeping, food service and nurse technician duties are combined to form one nurse-extender role: the Patient Service Partner (PSP). Findings about patient and nurse satisfaction before and after implementation show that nurses agreed that the PSP program improved patient care delivery and helped control costs. Patients reported the same or higher rating of satisfaction with various aspects of their hospitalization. Call lights were answered more quickly and attitudes of personnel answering the lights were more positive. Nurses are finding more time for patient education and documentation.     

Nursing leadership: to thrive in a world of change

Change is becoming the norm in health care environments. Nurse executives in leadership positions are an essential part of an institution's ability to adapt successfully and flourish with change. It is important for the nurse executive to have a clear concept of leadership, the change process, and organizational cultures. This will allow the nurse executive to create an environment within the organization where change is seen in a positive manner and staff are empowered to meet the challenges of health care today.     

Brief psychotherapy and psychological assessments: Entering a relationship, establishing a focus, and providing feedback.

Brief psychotherapy is aimed at facilitating change within a circumscribed time frame. To do this, therapists in this specialty actively engage clients, establish a focus to the treatment, and provide ongoing feedback throughout treatment. The authors show how using these features of brief psychotherapy in the assessment process can enhance the clinical usefulness of an assessment. By also incorporating an emphasis on respect for the client, in line with existential/client-centered principles, psychological assessments can be made more personally relevant and meaningful for the client. The approach outlined has been useful within a hospital-based, adult inpatient and outpatient mental health service in which assessments are conducted before starting psychotherapy or as clinical activities in themselves (e.g., psychodiagnosis). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PhD graduates and the demands of faculty roles

An investigation for serious illness can be terrifying for the client. While diagnostic procedures are a high priority, a supportive interpersonal approach for the fear the client is experiencing is also a significant aspect of client care. The nurse is in the ideal position to provide such support and have a significant impact on the client's psychological state.     

Antibiotic sensitivity of hospital strains of Staphylococcus

1. Changing trends in health care reflect increasing involvement with clients and families in the development of treatment plans, such as self medication planning. 2. Acting as an advocate for the client, the nurse, in consultation with the client and the multidisciplinary team, developed a consumer-centered program, which allowed the client to master a complicated medication regime prior to discharge. 3. Discharge planning, follow-up, and evaluation of medication compliance, ensured continuity of care, successful outcomes, and reduced use of in-hospital health care dollars.     

The intersubjective perspective and the client-centered approach: Are they one at their core?

Reviews the change from a 1-person to a 2-person psychology in psychoanalysis. In particular, R. D. Stolorow's (1994) intersubjectivity theory is presented and then contrasted with the client-centered approach to therapy. It is concluded that contemporary client-centered therapy is a 2-person psychology, and that well-trained client-centered therapists do reflect on their own subjectivity and how it influences the client. With their important similarities it seems that the client-centered and self psychology approaches to therapy are one at their core. Self psychology has more elaborate theorizing about the therapy process, while the client-centered approach is interested in applying its principles outside of therapy so that people can live more constructively. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiskilling: a survey of occupational therapy practitioners' attitudes

OBJECTIVE: Multiskilling has been identified as one means of reducing she cost of health care. This study examined occupational therapy practitioners' knowledge of multiskilling, how it is affecting service delivery and quality of care, and how therapists believe the addition of skills should occur. METHOD: A questionnaire was constructed for the survey and mailed to a random sample of 200 occupational therapists and occupational therapy assistants, all of whom were members of the American Occupational Therapy Association. RESULTS: The 117 respondents had a moderate understanding of multiskilling. They responded that multiskilling is beneficial to both the occupational therapy profession and the clients it serves, but they were also aware of its potential risks or disadvantages. According to respondents, multiskilling occurs formally through defined protocol and; more commonly, informally, driven by necessity and the desire to treat the client most effectively. CONCLUSION: The results indicate a need for the occupational therapy profession to define multiskilling and cross training; develop ways of serving clients that respond to administrative needs and constraints while preserving the uniqueness of occupational therapy; and monitor treatment outcomes of all service delivery methods to provide information regarding efficiency, effectiveness, and client satisfaction.     

Client-initiated homework in client-centered therapy.

This article explains the way homework is integrated into client-centered therapy (sometimes called person-centered therapy). It first presents a summary of the theory based on Carl R. Rogers' therapeutic conditions (congruence, unconditional positive regard, and empathic understanding), emphasizing the importance of the nondirective attitude. It describes Rogers' change theory based on unconditional positive regard and illustrates the therapeutic interaction process with segments of a typical session conducted by Rogers. Homework is then described and explained as almost always initiated by the client, with therapists' responses that range from pure empathic following to occasionally providing suggestions and instructions. The results of a small survey of nondirective client-centered therapists concerning homework are summarized, and several client/therapist interactions relating to homework are described. Homework in client-centered therapy, when it does occur, is an outcome of clients' initiatives and is consistent with the way the therapy fosters and protects clients' autonomy, self-determination and their sense of self. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Basic musculoskeletal assessment: tips for the home health nurse

Home care clients typically present with functional deficits that are frequently attributable to musculoskeletal abnormalities. This article teaches the home care nurse how to conduct a basic musculoskeletal assessment and how to use the findings to develop a thorough plan of care for the home care client.     

Nurse managed occupational health centers: an overview

1. Nurse managed centers provide clients with direct access to professional nursing care. 2. Lillian Wald, Mary Breckenridge, and Margaret Sanger established nurse managed centers at the beginning of this century. 3. Primary, secondary, and tertiary prevention programs and services are based on the mission, outcomes, staffing, and financing of the occupational health center. 4. Essential parameters for comprehensively evaluating an occupational health nurse managed center include, client outcomes, client satisfaction, and cost-benefit.     

Tarasaurus Rex: A Standard of Care That Could Not Adapt.

The duty to protect the public inspired by Tarasoff promotes lay action, primarily warning, to protect foreseeable victims of outpatient-generated harm. The nonadaptability of lay protection to professional practice has been highlighted as contemporary research and service delivery center on the management of risk of harm through clinical interventions. The authors attribute the emphasis on lay protection to 2 flaws underlying these legal duties: the framing of foreseeability of harm as prediction rather than as risk and the failure to distinguish responsibilities intrinsic to the clinical professions from those delegated to the clinician. A reformulation of the duty, sensitive to these dimensions, promotes a standard of protection emphasizing clinical interventions without precluding lay protection. The result is a duty of care consistent with research developments in risk and highly adaptable across service delivery, clinical settings, and client populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is anybody home? Basic neurologic assessment of the home care client

Clients with strokes, Parkinson's disease, multiple sclerosis, brain injury, or other conditions that are neurologic in origin abound in home care. Other clients may have neurologic deficits that are not so obvious. This article describes basic neurologic assessment and how it can be performed in the home setting with minimal inconvenience to the client and the nurse. Using a catchy mnemonic, the home care nurse can ensure that valuable information is obtained during the visit.     

The challenge to meet the mental health and biopsychosocial needs of the poor: expanded roles for hospital social workers in a changing healthcare environment

Despite the absence of coordinated federal health care reform, social workers in hospital settings have opportunities to identify, develop, advocate for, and facilitate access to innovative health care services, resulting in improved capacity to meet the mental health and biopsychosocial needs of the poor and, potentially, reduced hospital costs over time. There are opportunities for expanded roles for social workers in forging better linkages between hospital services and the community, developing an integrated biopsychosocial healthcare delivery system within hospitals and primary care settings, utilizing information systems as tools in an integrated system, and advocating for a client-centered approach to mental health services.