Risk factors for the spine: nursing assessment and care

The present work aimed at studying risk factor that affect people with back pain, identifying them and implementing an intervention proposal of a health education program based on self-care teaching, existential humanist philosophical projects and stress equalization approach line, skeletal-muscle reintegration activities, basic techniques on stress equalization and massage. It has been developed for a population of 42 (forty-two) clients. Two instruments which integrate nursing consultation protocol have been used in data collection. The results showed the existence of associated risk factors which are changeable according to health education programs. The assessment process has contributed for therapeutic measures focus, using non-conventional care methods for this approach providing an improvement to these clients life quality.     

Managed care and reproductive health

Managed care poses special challenges to midwives providing reproductive health care. This is owing to the sensitive nature of issues surrounding reproductive health and aspects of managed care that may impede a woman's ability to obtain continuous, confidential, and comprehensive care from the provider of her choice. Variations across payers (ie, Medicare, Medicaid, and commercial insurers) regarding covered benefits and reimbursement of midwifery services also may create obstacles. Furthermore, some physicians and managed care organizations are embracing policies that threaten the ability of midwives to function as primary health care providers for women. Despite these hurdles, midwives have the potential to remain competitive in the new marketplace. This article underscores the importance of being knowledgeable about legislation and policy issues surrounding the financing of midwifery services, quality performance measurement for HMOs as they pertain to reproductive health, and discussions regarding which clinicians should be defined as primary care providers.     

Population-based primary health care for women. An overview for midwives

This home study program has as its focus population-based care for women. Although clearly significant, concentrating effort solely on the individual does not ensure that the population as a whole is healthier. Experts are encouraging health care providers to consider the population as their "patient" and to begin documenting the incidence and prevalence of its disease. This article addresses the following issues: the definition of population-based health care; the relationship between primary care, women's health care, and population-based health care; the importance of a population-based approach or perspective for midwives; the use of population-based care in the provision of prenatal care; the definition of the populations to whom midwives have historically provided care and the documentation of how those populations are changing; and the research and policy issues for midwives related to population-based health care.     

Depression scales in schizophrenia: a critical review

In Sweden, nurse-midwives in primary health care are responsible for taking Papanicolaou smears in population-based cervical cancer screening programs. This article discusses the manner in which a group of nurse-midwives, working with the cervical cancer screening program, view both opportunities and burdens inherent in their work. Semistructured interviews were conducted with 21 nurse-midwives engaged in screening at seven antenatal health care centers in demographically different parts of Stockholm, using a team approach to collect and inductively analyze the interviews. Results indicate discrepancies between ideals guiding the midwives and their practice. Positive aspects described by the midwives appear to be related to an ideology of care, whereas perceived burdens include the midwives' sense of powerlessness, lack of congruence between midwives' ideology and screening organization, and lack of professional familiarity with cancer. Several of these features can be related to issues that are challenges for many health care practitioners today, even in other settings. Our conclusion is that the screening program has latent potential for further development of the role of the nurse-midwife as an advocate for women throughout the lifespan and in a variety of situations.     

Quality assessment in mental health.

Discusses assessment studies related to quality of care in the mental health field. Quality assessment involves defining quality of care, choosing an appropriate focus of quality-of-care studies, identifying applicable and feasible methods, and guaranteeing the reliability and validity of the data used in the assessment. It is concluded that (a) dogmatic statements about methods to assess the quality of mental health care should be avoided; (b) because it is difficult to ensure that process or outcome criteria are valid for use in quality-of-care studies, the establishment of such criteria must be done carefully; and (c) there are some general guidelines related to the sound execution of quality assessment studies. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring psychosocial work quality and health: Development of health care measures of measurement.

Demands on workload and work efficiency have increased because of ongoing global changes in health care organizations. Assessing and evaluating effects of changes on organizational and individual well-being require valid and reliable methods. Questionnaires from 3 large health care studies were used to develop instruments for work quality and health. Study 1 included 2,935 participants from all occupational groups. Study 2 sampled 3,545 nurses and midwives. Participants in Study 3 consisted of 3,506 employees at a large hospital. Variable fields of work quality, health and well-being, and modifying factors were factor analyzed with replicated structures in new samples, including 6 factors of work quality, 5 health factors, and 2 modifying factors. All except 2 factors had high internal consistency (Cronbach's α?=?.69–84) and low factor intercorrelations within areas. Social climate (but not individual resources) had, according to our model, a modifying effect on the work-health interaction (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Program evaluation for organizational cultural competence in mental health practices.

Mental health practices that lack cultural competence prevent diverse clients from receiving the care they deserve. As providers and program administrators, psychologists currently have a responsibility to ensure high quality of care for diverse clients at the clinic level. This article deciphers extant empirical research, organizational theory, public policy literature, and best practices to identify which recommendations are most relevant for those in small mental health practices and clinics. The authors present 10 components for culturally appropriate care, ranging from policies and procedures to needs and satisfaction level of clients. This overview can be used to help evaluate and develop a mental health practice's ability to meet the needs of diverse clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of laparoscopic ultrasound in cancer management

Clinical practice guidelines have enormous potential to improve the quality of and accountability in health care. Making the most of this potential should become easier as guideline developers integrate guidelines within information systems and electronic medical records. A major barrier to such integration is the lack of computing infrastructure in many clinical settings. To successfully implement guidelines in information systems, developers must create more specific recommendations than those that have been required for traditional guidelines. Using reusable software components to create guidelines can make the development of protocols faster and less expensive. In addition, using decision models to produce guidelines enables developers to structure guideline problems systematically, to prioritize information acquisition, to develop site-specific guidelines, and to evaluate the cost-effectiveness of the explicit incorporation of patient preferences into guideline recommendations. Ongoing research provides a foundation for the use of guideline development tools that can help developers tailor guidelines appropriately to their practice settings. This article explores how medical informatics can help clinicians find, use, and create practice guidelines.     

Teamwork in primary care: the views and experiences of nurses, midwives and health visitors

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England. It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices. Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork: team identity; leadership; access to general practitioners; philosophies of care; understanding of team members' roles and responsibilities; and, disagreement regarding roles and responsibilities. Differences in the various views and experiences of teamwork were identified. Midwives and health visitors emerged as the least integrated members of the primary health care team. Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups. The potential for teamwork in the future is discussed.     

Predictors of brief smoking intervention in a midwifery setting

The aims of this study were: to assess current practice in smoking cessation interventions by midwives and to examine the relationship between the use of smoking intervention, practitioner characteristics and organizational factors. A mail-out survey was sent to a random sample of 500 midwives. The response rate was 85% (n = 425). The results indicated that most midwives used minimal interventions (advice and education) for at least some of their clients. However, the more skilled and more time-intensive forms of intervention such as counselling about methods to quit, negotiating a quit date and follow-up were infrequently utilized. Moreover, participants estimated that half their smoking clients were not offered any advice about smoking. Organizational factors such as: hospital policy for smoking intervention, type of hospital, size of hospital, cohesion of staff and work pressure predicted the use of smoking interventions. Self-reported ability to intervene for smoking and the level of assessment undertaken were practitioner characteristics which predicted the use of smoking interventions. The barriers that inhibit the use of smoking intervention by midwives are discussed and methods for change canvassed.     

Optimizing smoking cessation strategies

Smoking cigarettes remains the leading cause of preventable illnesses and premature deaths in the United States. Although approximately half of living Americans who have ever smoked have quit, recent studies show that more than 70% of current smokers would like to stop smoking. Health care providers can enhance smoking cessation in their clients by performing assessments of both the physical and psychologic addictive aspects of smoking as well as past and current cessation barriers. Based on the assessment, the clinician should formulate a treatment plan by individualizing appropriate education, counseling, motivation, and pharmacologic support. This article reviews the prevalence and hazards of smoking and supplies health care providers with interventions to assist clients in becoming and remaining nonsmokers.     

The effects of emotional behaviour on components of the respiratory cycle

Clinical guidelines can be viewed as generic skeletal-plan schemata that represent clinical procedural knowledge and that are instantiated and refined dynamically by care providers over significant time periods. In the Asgaard project, we are investigating a set of tasks that support the application of clinical guidelines by a care provider other than the guideline's designer. We are focusing on the application of the guideline, recognition of care providers' intentions from their actions, and critique of care providers' actions given the guideline and the patient's medical record. We are developing methods that perform these tasks in multiple clinical domains, given an instance of a properly represented clinical guideline and an electronic medical patient record. In this paper, we point out the precise domain-specific knowledge required by each method, such as the explicit intentions of the guideline designer (represented as temporal patterns to be achieved or avoided). We present a machine-readable language, called Asbru, to represent and to annotate guidelines based on the task-specific ontology. We also introduce an automated tool for the acquisition of clinical guidelines based on the same ontology, developed using the PROTEGE-II framework.     

Prevention of group B Streptococcus infection in neonates

OBJECTIVE: To review the epidemiology of group B Streptococcus (GBS) infection, risk factors for infection, and clinical manifestations of disease in the neonate, as well as the role of chemoprophylaxis and immunoprophylaxis in prevention of GBS disease and current recommendations for prevention. DATA SOURCES AND STUDY SELECTION: MEDLINE searchers (1976-1997) of the English-language literature. DATA SYNTHESIS: Despite clinical advances in health care in the past two decades, GBS remains a leading cause of serious neonatal infection. Most early-onset GBS infections can be prevented through the use of intrapartum antimicrobial chemoprophylaxis. Preventing GBS infection in neonates is more cost-effective than treating GBS infections, and implementing prevention programs can reduce morbidity and mortality resulting from GBS disease. Many proposals have been made regarding prevention strategies; however, they have not been implemented widely and consistently in the US. To coordinate both pediatric and obstetric supported strategies, the Centers for Disease Control and Prevention (CDC) recently published recommendations for prevention of neonatal GBS disease through two possible strategies. In the first strategy, intrapartum antibiotic chemoprophylaxis should be offered to all women identified by prenatal culture as colonized and those who develop premature membrane rupture or onset of labor at less than 37 weeks gestation. The second strategy involves administration of intrapartum antibiotics to all women who develop one or more risk factors at the time of membrane rupture or onset of labor. CONCLUSIONS: GBS is difficult to eradicate, causing many women to be colonized with the organism during pregnancy and labor, thereby infecting their infant. Prevention strategies have been published for more than 10 years without successful implementation. Although optimal prevention management has not been defined, following one of two strategies recommended by the CDC can prevent the majority of GBS infections in neonates.     

The delivery of culturally sensitive health care to Native Americans

Cultural factors significantly influence the Native American's perspectives of traditional professional health care practices. To most effectively deal with Native American clients, health care providers must understand, respect, and demonstrate sensitivity to the values and implications of the Native American culture. A basic understanding of a group's cultural beliefs, values, and practices will enable the holistic nurse to appreciate the importance of appropriate interactions and techniques and, therefore, make health care more readily accepted. This article reviews the health and illness beliefs, the traditional remedies, the critical need for holistic health care, and the Five Great Values that guide Native American behavior. Familiarization with these cultural components will facilitate the provision of quality, holistic health care through improved interactions with Native American clients.     

Multistate case-control study of maternal risk factors for neonatal group B streptococcal disease. The Active Surveillance Study Group

Risk factors for early onset disease (EOD) caused by Group B streptococci (GBS) that are the foundation of prevention guidelines were identified in studies conducted in a few hospital centers. We investigated cases of EOD identified through laboratory-based active surveillance during 1991 and 1992 in a multistate population of 17 million. Ninety-nine cases were compared with 253 controls matched for hospital, date of birth and birth weight. Prematurity (< 37 weeks of gestation) was present in 28% of cases; 53% of case mothers had rupture of membranes > 12 hours; and 48% reported intrapartum fever. The incidence of EOD in each surveillance area was higher among blacks. By multivariate analysis, case mothers were more likely than controls to have rupture of membranes before labor onset (adjusted odds ratio 8.7, P < 0.001), intrapartum fever (adjusted odds ratio 11.9, P < 0.001), and history of urinary infection during pregnancy (adjusted odds ratio 4.3, P < 0.05). Young maternal age was also associated with risk of disease. Three-fourths of case mothers had intrapartum fever, < 37 weeks of gestation and/or prolonged rupture of membranes, indicators previously used to select high risk women for intrapartum chemoprophylaxis. Our findings extend data from single hospitals and suggest prenatal screening and selective intrapartum chemoprophylaxis of high-risk mothers could potentially prevent the majority of EOD in the United States.     

Perioperative antibiotics in nonemergency bowel surgery: a quality improvement project

BACKGROUND: Guideline development has received considerable attention recently; guideline implementation less. For various reasons, reports of guideline implementations are not common in the published literature. In this paper, we report the results of a multisite quality improvement project undertaken as part of Health Care Financing Administration's Heath Care Quality Improvement Program. METHODS: Six acute care hospitals were selected for participation according to the number of procedures during the calendar year 1993. Baseline and postintervention data were abstracted from the medical records of patients having bowel surgery. Performance feedback, education, and process improvement facilitation were the principal interventions used by the investigators; quality improvement plans varied by participant. Baseline and postintervention indicators were calculated. RESULTS: Statistically significant and practically meaningful improvement was observed in the primary indicator and in 4 of 11 subindicators. Conservative estimates indicated modest cost savings. CONCLUSIONS: Administration of perioperative antibiotics in bowel surgery can be improved by guideline implementations based on a continuous quality improvement model.     

Undercover careseekers: simulated clients in the study of health provider behavior in developing countries

The simulated client method (SCM) has been used for over 20 years to study health care provider behavior in a first-hand way while minimizing observation bias. In developing countries, it has proven useful in the study of physicians, drug retailers, and family planning services. In SCM, research assistants with fictitious case scenarios (or with stable conditions or a genuine interest in the services) visit providers and request their assistance. Providers are not aware that these clients are involved in research. Simulated clients later report on the events of their visit and these data are analyzed. This paper reviews 23 developing country studies of physician, drug retail, and family planning services in order to draw conclusions about (1) the advantages and limitations of the methods; (2) considerations for design and implementation of a simulated client study; (3) validity and reliability; and (4) ethical concerns. Examples are also drawn from industrialized countries, related methodologies, and non-health fields to illustrate the issues surrounding SCM. Based on this review, we conclude that the information gathered through the use of simulated clients is unique and valuable for managers, intervention planners and evaluators, social scientist, regulators, and others. Areas that need to be explored in future work with this method include: ways to ensure data validity and reliability; research on additional types of providers and health care needs; and adaptation of the technique for routine use.