Supply and demand for cardiac nurses in Ontario: perceptions of CNOs.

This article presents the results of a nursing survey of cardiac care hospitals undertaken by a Cardiac Care Network of Ontario Consensus Panel on Cardiovascular Human Resources. The focus of the Panel was to identify areas of current or pending shortages in human resources and make recommendations to the Ministry of Health and Long-Term Care about human resource management in adult cardiac care in Ontario. The article presents the number and mix of full-time, part-time and casual nursing staff, the age distribution of RNs, and the number of vacant Registered Nurse (RN) positions for a sample of cardiac care hospitals in Ontario. Next a sample of Chief Nursing Officer opinions about factors contributing to current difficulties in recruiting RNs and the outlook for future shortages are presented. Implications for nurse managers are offered, including development of new recruitment and retention strategies, identification of further efficiencies in care provision, and a need for nurse manager involvement in debates about the future of how health care is provided in Canada.

An evaluation of the social recreation component of a community mental health program.

The paper describes the results of an evaluation designed to determine the effectiveness of the social recreation component of a community-based mental health program. The program is for individuals with serious mental health problems, with a particular focus on those who perceive deficiencies in their social relationships. Findings showed that the individuals who participated in the program, in varying frequency, reported significant improvements in their self-ratings of loneliness, self-esteem, social functioning, satisfaction with social relations and leisure activities, as well as general life satisfaction. The association between particular program- or client-related factors and the outcome variables were examined to provide insights into why people changed. The merits and limitations of the evaluation methodology are discussed.

The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates.

BACKGROUND: Procedural pain management for very low birth weight (VLBW) neonates has been minimal or nonexistent in most neonatal intensive care units (NICUs). OBJECTIVES: To compare the efficacy of developmentally sensitive behavioral interventions (nonnutritive sucking via a pacifier, positioning) and sucrose for relieving procedural pain in VLBW infants and to determine the influence of contextual factors (gestational age, postnatal age, birth weight, severity of illness, frequency of painful procedures) on pain response. METHOD: In a prospective randomized crossover trial, pain was assessed in 122 VLBW neonates using the Premature Infant Pain Profile following four randomly ordered interventions during consecutive routine heel lance procedures. RESULTS: Significant differences in pain existed among treatment interventions (F = 16.20, p < .0001). The pacifier with sucrose (F = 24.09, p < .0001) and pacifier with sterile water (F = 9.00, p = .003) significantly reduced pain. Prone positioning did not decrease pain (F = 2.24, p = .137). Frequency of painful procedures approached significance in influencing pain response (F = 3.59, p = .01). CONCLUSIONS: The most efficacious interventions for reducing pain from single painful events were the pacifier with sucrose and the pacifier with sterile water. Research on the efficacy and safety of implementing these interventions, alone and in combination, for repeated painful procedures is needed. In addition, research is needed on the influence of implementing these interventions on pain response and clinical outcomes (e.g., health status and neurodevelopmental status) in VLBW neonates in the NICU.

Creating a hospital-community infrastructure: challenges and benefits.

With rising public expectations and demands for increased accountability, hospitals will be even more challenged by their local communities to implement strategies such as those developed at SMH to enable community participation that assists the hospital in serving its local population into the future. In response to unique health needs of its local community, SMH created an Inner City Health (ICH) Program in the early 1990s to provide comprehensive inpatient, ambulatory, and community outreach services. To build on its philosophy to reduce barriers to health for disadvantaged populations, the ICH Research Program, the only one of its kind in Canada, was also established. This paper will describe and explore the formalised infrastructure between SMH and the community; its evolution, as well as SMH's involvement with its community in context of the hospital's relationships with its Board of Directors, the Toronto teaching hospital system, media and advocacy groups. The role of ICH research in influencing evidence-based clinical practice, innovations in health science education and government policy will also be discussed as part of the SMH's hospital-community infrastructure.

Comparing nursing costs for preterm infants receiving conventional vs. developmental care.

The incremental costs incurred by VLBW (less than 1,500 grams) infants during the first year of life accounted for one-third of the $11.4 billion spent in the U.S. on health care. Developmental care for VLBW infants focuses on light and noise management, coordination of interventions to minimize sleep interruptions and positioning/bundling the infant to prevent disorganizaiton and promote self-regulation. When compared to 60 VLBW infants receiving conventional NICU care, improved physiologic stability measures and fewer days in the NICU were recorded for the 60 VLBW infants cared for by nurses and trained developmental care specialists. Because the move from the NICU to the transitional unit occurred earlier for the developmental group of VLBW infants, and their nursing intensity needs were lower, the average cost savings achieved for this group was $4,340 per infant during the first 35 days of life or less if discharged.

Premature Infant Pain Profile: development and initial validation.

OBJECTIVE: Inadequate assessment of pain in premature infants is a persistent clinical problem. The objective of this research was to develop and validate a measure for assessing pain in premature infants that could be used by both clinicians and researchers. DESIGN: The Premature Infant Pain Profile (PIPP) was developed and validated using a prospective and retrospective design. Indicators of pain were identified from clinical experts and the literature. Indicators were retrospectively tested using four existing data sets. PATIENTS AND SETTINGS: Infants of varying gestational ages undergoing different painful procedures from three different settings were utilized to develop and validate the measure. METHODS AND RESULTS: The largest data set (n = 124) was used to develop the PIPP. The development process included determining the factor structure of the data, developing indicators and indicator scales and establishing internal consistency. The remaining three data sets were utilized to establish beginning construct validity. CONCLUSIONS: The PIPP is a newly developed pain assessment measure for premature infants with beginning content and construct validity. The practicality and feasibility for using the PIPP in clinical practice will be determined in prospective research in the clinical setting.

Developmental versus conventional care: a comparison of clinical outcomes for very low birth weight infants.

The purpose of this research was to describe the clinical profile of very low birth weight (VLBW) infants receiving conventional versus developmental care during their hospitalization and to determine the appropriateness of developmental-care interventions. A phase-lag study with 124 preterm infants indicated that although there were no significant differences in individual clinical outcomes, developmental care had a significant effect on the physiologic stability of the infant over time. Developmental interventions were used for all infants receiving the developmental-care intervention, with varying frequency.

Outcomes management in neonatal nursing clinical practice.

One approach for evaluating the quality and cost of patient care is through outcomes management. Outcomes management in a neonatal environment will be described within a structure-process-outcome framework. Outcomes will be presented from three perspectives: administrative, economic and clinical. The relevance and implications of outcomes management will be discussed.

Outcomes monitoring: adjusting for risk factors, severity of illness, and complexity of care.

Adjusting for risk factors, severity of illness, and complexity of care is important when comparing and interpreting outcomes. Current and future approaches for examining risk factors, severity of illness, and complexity of care are described within the contexts of administrative, economic, and clinical outcomes. Reasons why the current standardized instruments, computerized severity systems, and workload/intensity measurements, when used alone, are inadequate for outcomes monitoring are proposed. A more comprehensive model for outcomes monitoring is required, one that adjusts outcomes for risk factors, severity of illness, and complexity of care.

Establishing a meaningful relationship: case costing and clinical practice.

The authors provide an overview of the defining principles guiding the movement toward managed care in an organization. Specifically, the significance of linking case specific costs to clinical practice activities and how this supports outcome monitoring will be discussed. Sustaining a cost-quality balance in the delivery of health care is predicated on the development of integrated financial and clinical information systems.

The Case Management Model: an innovative approach to the delivery of patient care.

Because of trends in the health care environment, hospitals are restructuring to innovative patient care delivery systems. The Case Management Model, with its emphasis on quality patient care and cost containment, is gaining widespread recognition throughout Canada and the United States. In this paper, the Case Management Model is described in relation to nursing practice.

Investigation of Newborn Hyperbilirubinemia: Helping family physicians indentify newborns at risk.

The trend to early neonatal discharge underscores the need to detect and manage neonatal hyperbilirubinemia. In a retrospective study, 84 charts from newborns were audited for clinical hyperbilirubinemia. Jaundice was recorded for 29% of the newborns, 92% of cases appearing after the second day. Audits of additional 257 charts indicated that neonates delivered by cesarean section were twice as likely to develop jaundice.

The statistical analysis of matched data in psychiatric research.

Clinical studies in psychiatry frequently involve the analysis of matched pairs, in which each patient is matched with his or her psychiatric clinician. If the response variable of interest is dichotomous, then McNemar's chi 2 test for correlated proportions may be applied to the resulting data. However, this test assumes that the set of matched pairs are statistically independent, an assumption that is violated if some clinicians are matched with more than one patient. In this article we present alternatives to McNemar's test for dealing with this problem.