The role of the advanced practice nurse in the care of patients critically ill with cancer

A polar Fourier transform (PFT) method is described that facilitates determination and refinement of orientations of individual biological macromolecules imaged with cryoelectron microscopy techniques. A three-dimensional density map serves as a high signal-to-noise model from which a PFT database of different views is generated and against which the PFTs of individual images are correlated. The PFT produces rotation-invariant data particularly well-suited for rapid and accurate determination of orientation parameters. The method relies on accurate knowledge of the center of symmetry and radial scale of both model and image data but is insensitive to the relative contrast and background values of these data. Density maps may be derived from a variety of sources such as computer-generated models, X-ray crystallographic structures, and three-dimensional reconstructions computed from images. The PFT technique has been particularly useful for the analysis of particles with icosahedral symmetry and could be adapted for the analysis of single particles of any symmetry for which a crude model exists or can be produced.     

Integrated health care and the advanced practice nurse

As state-designed Medicaid reforms are enacted and commercial insurance carriers begin to manage care, advanced practice nurses (APNs) must be ready to aggressively pursue opportunities for clinical participation. Understanding the contractual obligations of becoming a provider, as well as adopting strategies for successful participation in these emerging integrated networks, will be critical for APNs. Successful contracting requires a carefully defined set of practice activities and a willingness to become a team player in a complex organization.     

Analysis and synthesis of the role of the advanced practice nurse

This is an exciting and challenging period for healthcare in our country. Many changes have already occurred within our system, and many more are on the horizon. As our system evolves, current nursing and healthcare literature describe the present and future needs of patients and communities, as well as how nurse practitioners (NPs) are playing an increasingly important role in providing health services in the United States. This role of the advanced practice nurse (APN), particularly the NP, is examined philosophically and in the context of changing healthcare needs and policies.     

Managing the occupational environment of managed care

The emergence of managed care has resulted in a practice environment buffeted by rapid and sweeping changes. Shifts in philosophy and approach to payment for health care affect the nature of the service and the method of its delivery. The occupational adaptation frame of reference is used to illustrate the challenges imposed by the physical, social, and cultural components of the changing occupational environment. Perceptions, observations, and concerns of middle level occupational therapy, physical therapy, social work, and nursing managers illustrate the impact of this new environment. Therapists are challenged to understand their own changing work setting and to apply the same effort to mastering its challenges as they would to examining the context of their patient's occupational performance and to designing and implementing an appropriate clinical intervention.     

Caring for the community: development of the advanced practice nurse role

The historical and contemporary impetus for research in nursing is presented in brief. The factors affecting research use in practice are numerous and complicated and include political, financial, ideological and professional spheres. Various strategies that may enhance research use in practice have been suggested and evaluated and these are discussed.     

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The hospital nurse's role in managed care

This article describes the staff nurse's role in managed care and can be used by nurse managers in the education process. An obstetric case study demonstrates the potential of increasing patient-care quality while reducing health care cost.     

Evaluating health plans and marketing the gastroenterology practice under managed care

More patients will have managed care in the future. Therefore, every practice should have a strategy for working with managed care organizations (MCOs). Learn how to evaluate an MCO and how to obtain detailed information about MCOs in your area. Know how to market your practice and build relationships between your group and MCOs. Develop a practice profile that outlines all the benefits that your group can bring to an MCO. Plan how you will respond when an MCO says, "No."     

The morass of managed care: has it a place for advanced practice nursing?

This study was undertaken to describe the most common symptoms experienced during pregnancy by couples with a history of infertility and to compare them with symptoms of expectant couples without a history of reproductive problems. The Symptomatology Inventory, a 42-item checklist of common pregnancy symptoms, was used. The 10 most frequent symptoms reported and their rank order were very similar for the women from both groups. Men from the two groups frequently reported similar symptoms, but differed on their rank order. This research provides evidence that in terms of pregnancy symptoms infertile and fertile couples are more alike than they are different.     

Research, practice, and managed care.

Examines the relationship between practitioners, researchers, and managed care. Managed care systems' basic purpose is to conserve as much as possible the health care dollar, and to provide rationale for the equitable distribution of public funds. Despite evidence that psychotherapy is an effective treatment, this well-documented conclusion continues to be assailed. Research has been used as a tool for undergirding the rationing of therapeutic services. Similarly, the demand for treatment manuals has been met and treatment manuals have been shown to be of value, although the value is limited. In the same vein, time-limited forms of therapy can produce change, but such changes will in most cases be modest. The author notes that it is one thing to recognize that in the face of a shrinking health care economy professionals must accept more or less severe restrictions imposed on their activities. However, it is quite another to create the impression that brief or time-limited forms of psychotherapy are fully comparable or even superior to more intensive and extended forms. There is also reason to believe that well-trained experienced therapists are superior service providers. The need for greater tolerance and realism in accepting what psychotherapy can and cannot do is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual assault: the role of the advanced practice nurse in identifying and treating victims

Sexual assault is the fastest growing crime in the United States with an estimate that one in four women will be sexually assaulted before she reaches 18 years of age. Nevertheless, only 1 in 10 rapes is reported to law enforcement authorities. Although victims face cross-generational and long-term physical, emotional, cognitive, sexual, and spiritual damage, they seldom share this history unless directly questioned by a clinician. This article reviews the rapidly growing body of literature on sexual assault and the negative health effects on female victims and their families. Sexual assault is defined, incidence is discussed, the aftermath is explored, and the roles of advanced practice nurses are examined.     

Negotiating the role of the practice nurse in general practice

The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant: the role of the practice nurse in providing primary health care; and the effective use of the practice nurse resource in the 'new' National Health Service. This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this. The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely. The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds. Practice nurses' accounts of the future, for example, focused on professional issues. General practitioners stressed the importance of role development which met their General Medical Service responsibilities. Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service. The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated.     

Building healthier communities in a managed care environment: opportunities for advanced practice nurses

Two paradigm shifts are occurring in health care: managed care and community partnerships. The distinct principles and trends of each paradigm are certain to determine the future practice of advanced practice nurses (APNs). The impact of managed care and community partnerships will affect the resource management, clinical decision making, and time management of APNs. Concomitantly, APNs will have opportunities to influence practice guidelines, individual and community decision making, cultural competence, and the cost-effectiveness of care in communities. Capitalizing on these opportunities will enhance the value of APNs to their managed care plan employer and their community.     

Managing wounds in a managed care environment: the integration concept

Integration is being discussed at all levels today in healthcare. The term is confusing and the literature provides numerous definitions and explanations. In general, integration refers to the coordination and reorganization of various healthcare units (such as home health care, acute care hospitals, and skilled nursing facilities) either horizontally, vertically, or via a combination of both. To discuss integration, a healthy understanding of managed care and healthcare trends are essential. With current and projected future trends serving as a backdrop, this article will attempt to describe various integration delivery models. The application of the above to wound care as a specific disease state serves as the closing message.     

The role of prevention in workers' compensation managed care arrangements

Managed care's emphasis on restricting costs may interfere with its ability to assume a prevention orientation. The authors present models, derived from group health and workers' compensation, of successful incorporation of prevention into managed care arrangements.     

The dilemma of managed care.

Responds to the article by L. S. Brown (see record 84-21642) regarding managed care and false memory movement issues in social justice-oriented psychology. The current author argues that Brown abandoned psychologists be declining to think through how responsible and ethical people can work their way out of binds. Buchholz also contends that a greater call to unity and action among psychologists is needed to fight the dehumanizing and threatening effects of the HMOs and insurance companies on mental health service delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of managed care: the national and Tennessee experiences

The United States is the only developed country with no national health care policy. What exists is a national health insurance system. The problem with this system arises when paying for health care for the poor, who often require the most expensive type of care for acute or episodic ailments. Managed care, though not a panacea, has the potential of providing the organization to effectively control costs and change the existing health care paradigm from one of fee-for-service inpatient care to one of ambulatory care, home-based care, and physician office-based procedures. An example of a state-based initiative that has cut medical costs is Tennessee's TennCare. Under TennCare, approximately 1.2 million Tennesseans are covered, nearly 400,000 of whom were previously uninsured. Such programs, both state and national, must now look to including prevention and wellness care to effectively change the underlying epidemiology of illness among the poor.     

Pheochromocytoma in pregnancy: considerations for the advanced practice nurse

Pheochromocytoma, a rare finding in pregnancy, is associated with significant risks for maternal fetal morbidity and mortality when undetected antenatally. The disease is commonly mistaken for hypertensive conditions of pregnancy. The advanced practice nurse may play a crucial role in early diagnosis based on a careful history and physical examination, clinical suspicion, diagnostic testing, and patient education. The management of a pregnant woman with pheochromocytoma is individualized for the woman, depending on gestational age, tumor location, and stabilization of the disease. A collaborative medical, surgical, and nursing team approach is needed. Pharmacologic intervention and surgical resection of the tumor(s) are the treatments of choice. Long-term followup is essential to detect malignancy and recurrence.