Participation in a national nursing outcomes database: monitoring outcomes over time.

The current and future climates in health care require increased accountability of health care organizations for the quality of the care they provide. Never before in the history of health care in America has this focus on quality been so critical. The imperative to measure nursing's impact without fully developed and tested monitoring systems is a critical issue for nurse executives and managers alike. This article describes a project to measure nursing structure, process, and outcomes in the military health system, the Military Nursing Outcomes Database project. Here we review the effectiveness of this project in monitoring changes over time, in satisfying expectations of nurse leaders in participating hospitals, and evaluate the potential budgetary impacts of such a system. We conclude that the Military Nursing Outcomes Database did meet the needs of a monitoring system that is sensitive to changes over time in outcomes, provides interpretable data for nurse leaders, and could result in cost benefits and patient care improvements in organizations.

The satisfaction of doing national work, the delight of change and a good salary: the health of British colonial nurses going to work in the concentration camps of the Anglo-Boer War (1899-1902).

During the South African/Anglo-Boer War(1899-1902), the British established concentration camps in retaliation to Boer guerilla fighters. Thousands of Boer women and children and thousands of blacks and "coloured" people were interned within these camps. The conditions in the camps were unsanitary and led to the death by disease,mostly respiratory illnesses, of many of the inmates. There were outcries in Britain over the camps among Liberal members of Parliament and social reformers such as Emily Hobhouse. In response to this, the Secretary of War sent an all ladies commission to South Africa. Their final report cited unsanitary conditions and insufficient camp administration as contributing factors to the high death rates.Among their recommendations was to increase the nursing staff. The Colonial Nursing Association provided nurses for these jobs. This article uses a previously unused archival source, the case notes of the medical advisor to the Colonial Office. In 1901-1902, he examined a group of nurses going out to work in the concentration camps of South Africa. This article presents the results of the examinations of 89 nurses, three of whom were rejected, and places them in the context of medical concerns at the time.

The nursing shortage. Implications for military nurses.

Trends relative to nursing vacancies are expected to exist into the next decade. Unlike the cyclical shortages of the past, this shortage may not resolve itself. The authors present five major factors in nursing that have led to the shortage and that contribute to its continuation. Because military nurses provide much manpower in the healthcare industry, shortages in their ranks will affect the entire healthcare system. The five factors were applied to the military nursing force to demonstrate that the military also feels the pinch of the current nursing shortage.

Quantitative applications: forecasting and costing nursing service at an Army community hospital.

The utilization of a quantitative method of forecasting, coupled with an existing patient classification system (the Army's Workload Management System for Nursing), provides a creative costing tool for managing nursing resources at military medical facilities. Although the nursing management options discussed in this article are focused on a downsizing situation at an Army Community Hospital, they are applicable throughout military medical facilities.

Nursing implications of the Department of Defense Coordinated Care Program.

As the Department of Defense implements the Coordinated Care Program (CCP), it is essential to examine the implications of such a change for nursing. The nursing aspects of a CCP must be designed with consideration of nursing's contribution to patient care and hence the relationship of nursing to quality, access, and cost containment goals. In this paper, following an overview of the CCP, three major nursing implications of the CCP are identified and addressed. These are: (a) the cost of nursing, (b) the structure of nursing, and (c) the role of nurses.