Two-leaflet artificial heart valve with the common turn axis for leaflets

Quality improvement, measurement, and accountability pervade all health care, including the agendas of nursing, other care providers, and consumer groups. One new face of quality is unequivocal: data will be more equitably shared among all groups for data-based quality judgments. This will emphasize quality more than cost with greater involvement of the citizens compared to health care providers, payers, and health care product suppliers. Emphasis on quality will allow patients to have a voice heard and amplified through the implementation of patient-centered outcomes in the computerized patient care record. This article describes the implications of the Nursing Outcomes Classification (NOC) for nursing information systems and the computer-based patient record.     

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.     

The art of nursing: the client-nurse relationship as a therapeutic tool

The C-N relationship is the cornerstone and essence of mental health/psychiatric nursing. However, that process has the same potential for nursing in general. The C-N relationship is an interpersonal, interactive, and ongoing relationship set up to assist clients in the continuous evolution toward quality health and well-being. Although this article focuses primarily on the mental health population, the value of a positive working C-N relationship is paramount in addressing all health care issues. The C-N relationship is, indeed, a therapeutic tool that can generate positive side effects, enhance treatment approaches, and greatly influence favorable health care outcomes. It is easy to apply, is flexible, and, when used effectively, can generate the power within health care situations to determine desired health care outcomes.     

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.     

Quality and outcomes management in gastroenterology

The delivery of medical care is undeniably changing. Resources are becoming increasingly scarce, and the progressive rise of health care expenditures needs to be restrained. Although the field of outcomes assessment is not well understood, it is increasingly being applied to the practice of medicine. The underlying goal of outcomes management should be to improve quality by identifying the most efficient use of finite resources and integrating these into practice guidelines. Although reduction of health care costs is important, it should be a secondary goal. Providers of health care must take an active role in outcomes research and management both in understanding and in implementing these techniques in medical practice. In doing so, it is essential that physicians maintain the proper emphasis on quality patient care.     

Education is the key to nurses' survival

Nurses must be prepared academically to survive in the current and future competitive world of health care. Bachelor's and master's degree programs enhance nurses' abilities to apply the nursing process in increasingly complex health care environments, to document patient outcomes, to study new ways of delivering quality nursing care, and to assume leadership roles that will guarantee nursing's position in a reformed health care system.     

Nurse managed occupational health services: a primary care model in practice

1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.     

Cultural competence: a priority for performance improvement action

An increase in diversity that has been accompanied by a sharp decrease in white Caucasian "mainstream" culture has made cultural competence a priority in nursing performance improvement. Each culturally diverse group defines health and illness differently. Most have a long and well-established tradition of folk health beliefs and practices, which strongly impact members' reactions to American standards of care--an influence on both patient satisfaction and treatment compliance. This article describes the culture--health care relationship and lists 10 indicators for measuring cultural competency. It presents a practical, systemwide model for the improvement of nursing care quality through enhanced cultural competency and lists resources, which can be used to both support and improve cultural competency throughout an integrated health care system.     

Case management: integrating roles in the subacute setting

Nurses have great potential to advance the professional practice of nurse case management in the subacute care industry. This health care setting has created a new arena in which nursing may adapt and redefine the role of the case manager to meet the needs of an integrated system of outcomes based health care. Through cooperation and collaboration with a multidisciplinary team, the nurse case manager increases the cost effectiveness of care and enhances patient outcomes.     

On-line polymerase chain reaction (PCR) monitoring

Outcomes management has received increased attention in the current health care environment, but nursing participation has been limited due to the lack of standardized data about the effects of nursing practice. The Nursing Outcomes Classification (NOC) provides a standardized language that can be used to measure the effects of nursing practice on patient outcomes. An overview of the classification and implementation methods is provided.     

Outcomes research: a review

PURPOSE: The purpose of this article is to review the history of the medical outcomes movement as well as the methodologies used in outcomes research. CONCEPT: Outcomes research refers to a genre of clinical investigation that emphasizes the measurement of patient health outcomes, including the patient's symptoms, functional status, quality of life, satisfaction with treatment, and health care costs. RATIONALE: Outcomes research evolved from studies that demonstrated the presence of wide geographic variations in the practice of medicine and surgery. Such differences in utilization were unaccompanied by any discernible difference in patient outcomes. With escalating health care costs, there has been a growing interest in measuring the outcomes of medical intervention to determine the quality and appropriateness of medical care. DISCUSSION: Outcomes may be measured both directly and indirectly, over differing periods of time, and with varying degrees of objectivity, reliability, and validity. Current research has focused on quality of life issues, which include the extent to which a patient's usual or expected physical, emotional, and social well-being have been affected by a medical condition or treatment. The true value of health care can be determined only by a systematic examination of patient outcomes. To accomplish this goal, methods are required that are relatively unfamiliar to many clinical researchers. Future clinical research should include patient-oriented outcome measures that would otherwise focus solely on physiological or anatomic outcomes. Such information will be essential in determining which medical and surgical treatment strategies should be abandoned and which will gain acceptance in the future.     

Quality of life after cardiac surgery

Tremendous strides have been made in the surgical treatment of cardiac disease. Research has documented many physical and psychologic benefits for the patient, but many questions remain unanswered. The change in quality of life may be the single most important outcome of cardiac surgery. This issue has received considerable attention in professional literature in recent years, particularly in the midst of rapidly expanding technology and soaring health care costs. This article reviews the literature related to the quality of life of cardiac surgical patients. Specific topics, such as physiologic and psychologic outcomes, return to work, family responses, and issues related to transplant patients, are discussed. The article includes a discussion of nursing implications.     

Failure of erythropoietin treatment in a case with primary autonomic failure

All prisons provide healthcare services which aim to meet the needs of prisoners. The goal of the service is to give prisoners access to the same quality and range of health care as the NHS gives the general public. However, within the prison environment priorities centre around order, control and discipline and therefore an ethos of health care needs to be developed. Custody reduces the prisoner's opportunity for self-care and independent action as inmates have to consult nursing or medical staff for even the most simple remedies. Nursing staff in the prison service can play a significant part in primary health care, mental disorder and health promotion. Nurses have the knowledge, skills and attitudes needed to deal with this diverse and vulnerable prison population and to promote a positive interface between custody and care.     

LHRH neurons migrate into the trigeminal nerve when the developing olfactory nerve fibers are physically interrupted in chick embryos

Multiple methods of tocolysis and fetal surveillance provide unprecedented ways to improve multifetal outcomes through meticulous antepartum care. Although few practitioners have much experience with these complicated pregnancies, knowledge is growing with the increasing incidence of multifetal pregnancy. A review of the current literature regarding antepartum surveillance provides the basis for a discussion of the techniques essential to quality nursing care during multifetal pregnancy. Guidelines are provided for nursing standards in documentation, terminology, and care during surveillance of multiple fetuses.     

Implementation of a professional practice model for nursing in a rural hospital

Growing concern about rural hospitals and the health of rural citizens highlight the need for high quality, progressive nursing care. To address this concern, several program changes to improve patient and organizational outcomes were made in one rural hospital; implementation success varied. Hospital culture and changes occurring within the health care environment affected the change process.     

In vitro metabolism of cyanohydroxybutene: formation of a glutathione-S-transferase catalyzed product

This paper examines the financing of elderly health care in Japan for medical institutions, nursing homes, and at home. The analysis demonstrates that the conventional figures for elderly health expenditures in Japan systematically underestimate the real costs by excluding the costs of uninsured services, nursing homes, and home health care. The paper estimates these costs and shows that they add about 10% to the conventional figure for elderly health care costs in Japan. This inquiry also shows how government policy for health care financing shaped distinctive Japanese patterns of elderly care provision. The financing system provided a hidden subsidy--through national health insurance coverage of long-term hospitalization--that encouraged high institutionalization rates of elderly in medical facilities. Public financing for long-term elderly hospitalization, however, has not been matched by government attention to quality of care, resulting in serious quality problems and reflecting a social trade-off between cost and quality. Also, until recently the financing system rarely reimbursed home health care, thereby creating strong disincentives to the development of formal home health care services. This analysis has important implications for reforms now being considered by the Japanese government in the financing and provision of health care for the elderly, especially the limitations of relying on reimbursement price policy. The reforms could have unintended negative consequences for equity, efficiency, and quality of care.     

Muscles in the Drosophila second thoracic segment are patterned independently of autonomous homeotic gene function

Legislated health care reform was a primary issue of concern and activity during the early part of the Clinton administration. Nursing was among those disciplines with proposals for change. Although legislated health care reform failed to achieve congressional approval, the momentum for change continued and has contributed to a newly emerging, market-driven health care environment. Professional leadership is needed to lend perspective to the many health care innovations. Nurses should play an important role in this leadership, but they must rise above some of their own divisiveness to do so. Strategies for the development of nursing policy aimed at achieving this goal are discussed.     

Improving delivery of care through change management

This article describes an evidence-based care initiative and programme of clinical change which set out to improve the delivery of nursing care and related health outcomes for mentally disordered offender patients at Rampton Hospital. The programme has implications for all nursing specialties with studies also validated in mainstream psychiatric and general nursing contexts.     

Surgery on the crystalline lens. A plan of standardized care

In these days of concern for the growing costs of medical care it is an opportune moment to promote the importance of nurses as health care professionals and the roles that they play. This article presents a structural care plan for specific clinical situations regarding lens surgery with the goal of both guaranteeing quality nursing care and a method to evaluate costs. Lens surgery, a equently performed operation in the hospital, is used as an example to evaluate criteria of adequate service and efficiency. This method is based upon L.J. Caronito s bifocal model of clinical nursing.