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.     

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)     

Evaluation of a multidrug chemotherapy protocol (ACOPA II) in dogs with lymphoma

The introduction of market forces into health care delivery systems has had a number of important influences on the roles nurses perform. There have been increasing efforts to find alternative and more cost-effective ways of delivering care. One facet of this situation has been the examination of the roles and responsibilities of registered nurses (RNs) with the view of exploring different ways of using professional skills and determining if RN services are always required. One result of this has been the increased use of unlicensed personnel. The substitution of professional nursing staff by unlicensed personnel has become a major concern for practitioner, manager and client alike. This paper reviews some of the concepts of economic substitution as well as the assumptions advanced for the use of unlicensed personnel in clinical areas as a substitute for nursing services. While there has been increased use of unlicensed staff, the evaluation of clinical outcomes has been poor. This paper reviews primarily the hospital-based evidence about the impact of using unlicensed personnel in practice, and suggests there are methodological problems with the research published to date. Findings suggest that substitute service providers generally 'do no harm'. By contrast, evidence is presented indicating the major contributions nurses make to client care when adopting advanced practice roles (acting as a substitute for other professionals).     

Effect of caffeine ingestion on perception of effort and subsequent work production

The chief nurse officer brings the value-adding contribution of client partner to the executive management team. The nurse executive contributes professional nursing's client-centered, health-enabling approach to care delivery to assist organizations in developing new client and community services. The single most important leadership-challenge presented to nurse administrators, leaders, and managers is the ability to articulate a vision of client-centered care, demonstrate the costs and benefits of service innovations, and effectively shape organizational cultures to achieve innovations in service delivery.     

Therapist interpersonal skills: Process, outcome, methodological considerations, and recommendations for future research.

Reviews psychotherapeutic outcomes as they are related to such therapist interpersonal skills as empathy, regard, and genuineness. Professional and paraprofessional training programs that have grown out of the client-centered framework are also discussed. In addition, empirical research concerning confounding variables and the methodological shortcomings of this research domain are reviewed. Conclusions include (a) the idea that Rogerian hypotheses have been only modestly supported, and (b) that the lack of support is due both to the difficulties encountered in sampling and rating therapy sessions and to the failure of client-centered theory to specify more precisely the times when specific conditions (such as empathy) might be most facilitative. It is noted that judges' ratings of audiotape recordings of counseling have not provided better predictions of positive therapeutic outcome than have client perception measures of the counseling process. It is concluded that the efficacy of popular interpersonal skills training models has not been demonstrated. It is recommended that in addition to multiple criterion measures, researchers apply multiple process measures to assess the nature of the therapeutic relationship in outcome studies. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The education of depressed primary care patients: what do patients think of interactive booklets and a video?

BACKGROUND: Clinicians, policy makers, and health care administrators are attempting to improve depression outcomes in the primary care setting. Despite positive evidence about the efficacy of self-help materials and psychoeducational interventions, use of educational materials designed for the primary care patient are receiving little attention in present depression initiatives. The present study describes the use and evaluation of three educational materials by depressed primary care patients. METHODS: As a part of a randomized control trial, depressed primary care patients were identified by primary care physicians and randomized to a clinical trial exploring a new method of treating depression. Patients assigned to the new method of treatment received a package of educational materials at the time of the baseline interview. These materials included two brief interactive booklets (medication booklet, behavioral health booklet) and a short video. The present analysis concerns data obtained from 108 intervention patients in a telephone survey conducted 1 week after they received the package of educational materials. RESULTS: Approximately three quarters of the subjects reported that they read or viewed all of the educational products. The majority rated the products as somewhat to significantly helpful: medication booklet 81%; behavioral health booklet 82%; and video 69%. Previously reported results include findings of significantly better medication adherence and improved clinical outcomes by patients with major depression who received a primary care intervention that included the educational products discussed in this paper. CONCLUSIONS: Educational materials may play a significant role in improving depression treatment outcomes in the primary care setting.     

Preferences for three theoretically derived counseling approaches.

Examined differences in potential-client preference and believed effectiveness for counseling approaches based on behavioral, client-centered, and psychoanalytic theory using 57 college students. Analyses of S responses to randomly ordered same-client, same-problem demonstration tapes of each approach indicated that the behavioral approach was significantly more highly preferred and believed more effective than either the client-centered or psychoanalytic approach. No significant differences were found between ratings of client-centered and psychoanalytic approaches. While the preference for behavioral counseling merits further theoretical and empirical investigation, more importantly, preference and believed-effectiveness differences suggest that counseling outcomes should be investigated as a function of the acceptability to the client of actual counseling behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring outcomes in nursing centers: otitis media as a sample case

While it is generally recognized that NPs offer affordable, quality health care, few studies have measured outcomes of clients who seek primary care services from NPs. This pilot study describes the outcomes of children with otitis media who received care from NPs employed in an academic nursing center. Outcome measurements included issues related to timing, level of analysis, and attribution. Parents of 27 children participated in a telephone survey consisting of seven questions relating to the care their children received from NPs and their recovery path. Although every respondent reported having a positive visit at the nursing center, concerns for NPs surfaced during the process of measuring outcomes. This study emphasizes the need for measuring outcomes in nursing clinics and demonstrates one way to measures client outcomes, revealing both general health care and specific nursing practice implications.     

Finding value in nursing care: a framework for quality improvement and clinical evaluation

Fiscal constraints have heightened attention to health care costs and patient outcomes as measures of health care system effectiveness. Determining which patient and costs outcomes nurses may be held accountable for requires differentiating the impact of dependent, independent and interdependent nursing activities. A nursing role effectiveness model that includes a number of structural variables is offered to help track quality improvement and research activities. Some of the nurse-sensitive patient outcomes that have been identified include: freedom from complications, clinical outcomes, functional health outcomes, knowledge outcomes, perceived health benefit (or satisfaction), and costs outcomes. This model can be used to evaluate the effectiveness of current as well as evolving nurse roles, processes, and structural changes.     

Polypharmacy and older adults: A role for psychology and psychologists.

The literature and clinical experience confirm polypharmacy as an important contributor to avoidable morbidity and mortality among older adults. Sociocultural factors, along with the interplay among aging, physiology, chronic disease, and the medicines that seniors take play important roles in clinical presentations, conclusions drawn, interventions planned and implemented, and health care outcomes. Knowledgeable psychologists can help reduce the number and severity of common geriatric syndromes (e.g., falls and mental status changes) that our nation's elders suffer due to inappropriate polypharmacy. Providing high quality psychological services includes developing collaborative relationships with medication prescribers and participating in interdisciplinary teams, even if loosely defined (as is often the case at the community-based, independent practitioner level of care). Informed psychological interventions (including dynamic, cognitive, and/or behavioral) can effectively modify many older adults' medical and other health concerns, reducing the need for and risks associated with taking multiple medications. Participating in research, public education, and advocacy efforts in order to enhance the quality and effectiveness of the health care and services that older adults receive are also vital roles for psychology and psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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.     

Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom

This paper argues that the interfaces between formal and informal care-giving are changing as a result of two current trends; the increased scope of home-based nursing care and the emphasis on participation both within nursing and in the wider health and social care arenas. These various changes are explored in relation to the provision of intensive and complex nursing care in the home. It will be argued that the changing interfaces between formal and informal care have important implications for the respective roles of nurses and informal carers which hitherto have been relatively overlooked. These implications urgently need addressing in research, policy and public debate if professional nurses are to provide appropriate help and support to informal carers.     

The case management model of patient care delivery

Case management is a model of care delivery that integrates patient and provider satisfaction and consideration of cost factors and provides a method of managing individuals' holistic health concerns. Using the case management approach, nurses can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance clients' quality of life, decrease length of hospitalization, increase client and staff satisfaction, and promote cost-effective use of scarce resources. Case management offers nurses an opportunity to demonstrate their roles in multidisciplinary health care teams. Case management is relevant in ambulatory surgery settings and in the perioperative care of complex surgical patients.     

EPR evidence for the involvement of free radicals in the iron-catalysed decomposition of qinghaosu (artemisinin) and some derivatives; antimalarial action of some polycyclic endoperoxides

The role of pharmacies that specialize in the treatment of specific chronic diseases in the alternate-site health care setting is discussed. The optimal use of medications through disease management programs can improve patient outcomes and lower overall health care costs. The increase in disease management programs has spawned the growth of disease-specific pharmacies in the home care and other alternate-site health care settings. These pharmacies usually operate from a single location or are regionalized operations that deliver pharmaceutical products to patients throughout the United States. The pharmacies employ clinicians who specialize in a particular disease. These clinicians conduct comprehensive patient education programs, drug-use review, and compliance monitoring. Disease management pharmacies focus on chronic, expensive diseases; costs related to inventory, equipment, and storage can be very high. Many disease management pharmacies are involved in preferred-distribution or closed-distribution arrangements with pharmaceutical manufacturers. Pharmacists involved in disease management programs routinely send compliance information about their patients to pharmaceutical companies, managed care organizations, or prescribing physicians. Disease management pharmacies act as advocates for patients with particular chronic diseases. Various foundations and patient advocacy and research groups have created their own disease management pharmacies. Disease management has also reached the community pharmacy practice setting. Pharmacies specializing in the treatment of specific chronic diseases in the alternate-site health care setting can improve health care and promote efficient use of 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)     

Psychological care for persons of diverse religions: A collaborative continuum.

The purpose of this paper is to describe to psychologists and other clinicians a continuum of mental health care for persons of diverse religions. The continuum delineates boundaries between clinical care provided by mental health professionals and religious care provided by clergy, as well as describes pathways of collaboration across these boundaries. A prevention science based model of Clergy Outreach and Professional Engagement (COPE) is offered to guide this collaboration. The model describes a continuum that moves from the care already present in religious communities, through professional clinical care provided in response to dysfunction and returns persons to their own spiritual communities. One challenge for clinicians is that in addition to a wide diversity of beliefs and practices across religions, there is great ethnic diversity within religions. These diversities are reflected in varied correlations with mental health outcomes. Therefore, we recommend that clinicians assess religious beliefs and their cultural variations when designing religious inclusive psychotherapy specific to the client. There are ethical concerns as to the place of religion in clinical care. The “Resolution on Religious, Religion-Based and/or Religion-Derived Prejudice” adopted by the American Psychological Association has stated that it is not the role of professional psychologists to be spiritual guides. Through spiritual assessment of clients and strategic collaboration with religious leaders via COPE, mental health professionals can focus their efforts on clinical care that respects and incorporates the religious views of clients and does not attempt to recreate the lived religions of the clients' communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research contributions to improving managed health care outcomes.

Managed health care programs are beginning to look to findings from psychotherapy outcome research to help set policy, suggesting the need to consider outcomes research from the standpoint of usability or utility. It also provides an opportunity to integrate science and practice. Considering and applying outcomes in this context requires cooperation between scientists and practitioners, the willingness of each group to set aside guild agenda, and giving up favored but insupportable beliefs and practices on the parts of those in both scientist and practitioner camps. This type of cooperation may have mutual payoffs. This article considers some of the obstacles to this type of sacrifice and evaluates some of the potential costs of cooperating. It also provides perspectives on the new roles of psychological assessment and methods of outcome research that would provide a scientific basis for the function of managed health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The specific effects of a Gestalt intervention.

Reports 3 cases in which the effects on client depth of experiencing and voice quality of the Gestalt "2-chair" operation were investigated. In a design using the clients as their own controls, the effects on each client of 3 Gestalt operations, applied under experimental control to client statements of conflict, were compared with the effects of 3 active-empathy operations at similar points. Results confirm that following the Gestalt operation the depth of experiencing was significantly higher for each of the 3 clients selected as good prognosis clients for client-centered therapy. Two Ss used significantly more emotionally expressive voice after the Gestalt operation. The implications of the change in depth of experiencing on shifts in awareness and on the client's ability to cope with and resolve conflict are discussed. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)