Introducing case management to a general medicine ward team of a teaching hospital.

PURPOSE: To introduce case management to a general medicine ward team of a teaching hospital to improve patient care and ensure comprehensive longitudinal care. METHOD: The Department of Veterans Affairs Medical Center is one of four hospitals used by University of Oklahoma School of Medicine residents. There are five medicine teams, each comprising a second- or third-year resident, one or two interns, two medical students, and a faculty physician. The case-management program was initiated in November 1994. No attempt was made to limit the residents assigned to the case-managed team (i.e., many residents who worked with the case-managed team subsequently rotated through the other teams). Patients were assigned to the teams by rotation, and no attempt was made to adjust for the severity of illness among admissions. The teams were separated as follows: pre-case-management teams (all five teams prior to the case-management program), non-case-management teams (the four teams without case managers after the program's initiation), and the case-management team. The study periods were January-July 1994 (pre-case management) and January-July 1995 (after case management). RESULTS: The numbers of patients treated by the three groups were 1,305, 1,139, and 289, respectively. The median length of stay for pre-case-management patients was 5 days (interquartile range, 3-9 days); for non-case-management patients, 5 days (range, 3-8 days); and for case-management patients, 5 days (range, 3-7 days). The cumulative distribution of lengths of stay for case-management patients was significantly different from those of the other study groups by the Kolmogorov-Smirnov test (p = .02). More case-management patients were discharged by day 7. Rates of readmission were not significantly different between the teams. CONCLUSION: In this study a case-management program was effectively implemented in a teaching hospital, resulting in reduced lengths of stay for patients. As academic health centers become more concerned with efficiency and cost, case management should be seriously considered as a way to deal with such issues.

A community needs assessment for a SANE program using Neuman's model.

PURPOSE: To present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model. The guidelines provide advanced practice nurses with a holistic, systematic means to conduct an assessment prior to the implementation of a SANE program and facilitate collaborative work with other disciplines and agencies. DATA SOURCES: Selected research-based articles on sexual assault, classic texts and writings on Neuman's Systems Model, and community assessment models and programs. CONCLUSIONS: Sexual assault is a problem faced by almost every community. A thorough community assessment is an important first step in establishing programs that adequately meet a community's needs. Guidelines for conducting such an assessment related to implementation of a SANE program are rare, and guidelines using a nursing model were not found in the literature. IMPLICATIONS FOR PRACTICE: One program that has been successful in meeting community needs is the SANE program. A concise and organized assessment guide can reduce the necessary time and money allocated for a community assessment and can provide a basis for evaluation and research.

Continuity and discontinuity: the quality of life following stroke.

The purpose of this existential-phenomenological study was to investigate the experience of life after stroke rehabilitation, to provide a holistic view for nurses and others in providing care. Analysis involved a part-to-whole dialectic; selected transcripts, including the bracketing interview, were analyzed in an interpretive research group. There were 14 participants, with a 2-year median length of time since stroke; participants exhibited various disabilities. The world of the stroke survivor is grounded in a life of loss and effort from which emerged interrelated themes: independence/dependence, in control/out of control, and connection/disconnection with others. A fundamental aspect of these themes is a sense of continuity that coexists with discontinuity in the experience of self. The findings have implications for how nurses interact with stroke survivors, for goal-setting, and for specific strategies that focus on meanings for clients.

Q2 dependence of the neutron spin structure function g2(n) at low Q2.

We present the first measurement of the Q2 dependence of the neutron spin structure function g2(n) at five kinematic points covering 0.57 (GeV/c)2 < or = Q2 < or = 1.34 (GeV/c)2 at x approximately = 0.2. Though the naive quark-parton model predicts g2 = 0, nonzero values occur in more realistic models of the nucleon which include quark-gluon correlations, finite quark masses, or orbital angular momentum. When scattering from a noninteracting quark, g2(n) can be predicted using next-to-leading order fits to world data for g1(n). Deviations from this prediction provide an opportunity to examine QCD dynamics in nucleon structure. Our results show a positive deviation from this prediction at lower Q2, indicating that contributions such as quark-gluon interactions may be important. Precision data obtained for g1(n) are consistent with next-to-leading order fits to world data.