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1.
Orv Hetil ; 161(34): 1423-1430, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32804672

RESUMO

INTRODUCTION: Palliative, symptomatic and end-of-life care of advanced and metastatic cancer patients is a great challenge for every health care system. With the initiation and establishment of the multidisciplinary palliative tumor board (MPTB), our aims were the timely referral of patients to palliative care, and the avoidance of multiple unnecessary emergency visits and over-diagnostics without further treatment consequences. METHOD AND RESULTS: The MPTB meetings were held biweekly. The core members of the team were: palliative care consultant, medical oncologist, internal medicine physician, psychologist, psychiatrist, and oncology and palliative medicine nurses. From May 2019 till January 2020, we discussed the medical history of 97 cases of 93 cancer patients with advanced disease states; in one meeting the team usually discussed over 6-10 complex patient histories. In every case we determined the actual form of the necessary palliative care, e.g., outpatient clinic, home care, or institutional referral, and we decided on further possible and realistic oncology treatment regimes. A few months after the introduction of the new MPTB, we detected a decrease of the unnecessary emergency unit referrals considering the patients whose histories were discussed. CONCLUSIONS: Although the initial MPTB discussions had an intense emotional tone, they shortly became thoughtful and operational expert meetings. We believe that the MPTB system fully promotes the early and timely access of advanced cancer patients to appropriate palliative care and facilitates gradual changes in the medical oncologists' approach from the absolute curative determination to a supportive medical attitude. Orv Hetil. 2020; 161(34): 1423-1430.


Assuntos
Neoplasias/terapia , Cuidados Paliativos , Universidades/organização & administração , Conselho Diretor , Humanos , Hungria
2.
Oncol Res Treat ; 43(5): 196-203, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32222709

RESUMO

INTRODUCTION: Cancer clinical trial accruals have been historically low and are affected by several factors. Multidisciplinary Tumor Board Meetings (MTBM) are conducted regularly and immensely help to devise a comprehensive care plan including discussions about clinical trial availability and eligibility. OBJECTIVES: To evaluate whether patient discussion at MTBM was associated with a higher consent rate for clinical trials at a single tertiary care center. METHODS: Institutional electronic medical records (EMR) and clinical trials management system (OnCore) were queried to identify all new patient visits in oncology clinics, consents to clinical trials, and MTBM notes between January 1, 2011 and December 31, 2015. The association between MTBM discussion and subsequent clinical trial enrollment within 16 weeks of the new patient visit was evaluated using a χ2 test. RESULTS: Between January 1, 2011 and December 31, 2015, 11,794 new patients were seen in oncology clinics, and 2,225 patients (18.9%) were discussed at MTBMs. MTBM discussion conferred a higher rate of subsequent clinical trial consent within 16 weeks following the patient's first consultation in an oncology clinic: 4.1% for those who were discussed at a MTBM compared to 2.8% for those not discussed (p < 0.01). CONCLUSIONS: This study provides evidence that MTBMs may be effective in identifying patients eligible for available clinical trials by reviewing eligibility criteria during MTBM discussions. We recommend discussion of all new patients in MTBM to improve the quality of care provided to those with cancer and enhanced clinical trial accrual.


Assuntos
Institutos de Câncer/organização & administração , Ensaios Clínicos como Assunto/métodos , Neoplasias/terapia , Participação do Paciente , Definição da Elegibilidade , Feminino , Conselho Diretor/organização & administração , Humanos , Consentimento Livre e Esclarecido , Comunicação Interdisciplinar , Masculino , Seleção de Pacientes , Estudos Retrospectivos , População Rural , Centros de Atenção Terciária
5.
J Nurs Adm ; 50(2): 104-108, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929344

RESUMO

OBJECTIVE: The aim of this study was to develop a valid, reliable instrument to measure the effectiveness of shared governance councils BACKGROUND: The work of shared governance, that is, the decisions, takes place in its structures, notably, the councils. A literature search yielded no formal instrument for evaluating how these councils function. METHODS: A 4-phase process was used to generate valid items to measure shared governance council effectiveness, including content validity by experts, a pilot for feasibility, a larger pilot for internal consistency, and an exploratory factor analysis to delineate a final instrument. RESULTS: More than a dozen experts and participants from nearly 30 healthcare organizations contributed to the final development of the 25-item Council Health Survey instrument. Items for measuring council effectiveness at either the unit or division level were grouped in areas of structure, activities, and membership. CONCLUSIONS: When evaluating shared governance, nurses should focus on councils themselves, in which much of the work of shared governance occurs.


Assuntos
Governança Clínica/organização & administração , Eficiência Organizacional , Conselho Diretor/organização & administração , Colaboração Intersetorial , Cuidados de Enfermagem/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
J Nurs Adm ; 50(2): 61-62, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31977942

RESUMO

In this Inspiration Column, Pat Reid Ponte interviews Lisa J. Sundean, PhD, MHA, RN, associate professor, University of Massachusetts Boston. Dr Sundean has devoted her career to support the inclusion of nurses on boards.


Assuntos
Conselho Diretor/organização & administração , Papel do Profissional de Enfermagem , Cuidados de Enfermagem/organização & administração , Boston , Feminino , História do Século XX , História do Século XXI , Humanos
8.
J Leg Med ; 39(3): 229-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626576

RESUMO

Lapses in professionalism are a common cause of disciplinary action against physicians by U.S. medical boards. However, the exact definition of "professionalism" is unclear, making it likely that a physician will not train or practice under the same framing of professionalism and so may fail to develop certain skills. The goal of this study was to identify and compare the professionalism framings of medical boards. The medical board web pages for all 50 states, the District of Columbia, and four territories were examined in June 2017 for use of the word "professionalism" or "professional" in their application, rules, or laws, which was then coded as a best fit to one of six core framings of professionalism. Of the 55 states and territories, integrity was the most common professionalism framing (40.0%), followed by excellence (23.6%), behavior (12.7%), mixed (9.1%), unclear (9.1%), and absent (5.5%). Although integrity was the most common framing, diversity exists among medical boards, which could lead to board misunderstandings of incidents labeled as professionalism violations and ineffective remediation of offenses. In order to best communicate the nature of the offense and thus best facilitate remediation, the incident should be called by its true name rather than the all-encompassing term "professionalism."


Assuntos
Papel do Médico , Médicos/normas , Prática Profissional/normas , Profissionalismo/normas , Conselho Diretor/legislação & jurisprudência , Conselho Diretor/normas , Humanos , Má Conduta Profissional , Profissionalismo/tendências , Conselhos de Especialidade Profissional/legislação & jurisprudência , Conselhos de Especialidade Profissional/normas , Estados Unidos
9.
BMC Health Serv Res ; 19(1): 725, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638988

RESUMO

BACKGROUND: Patients are sometimes harmed in the course of receiving hospital care. Existing research has highlighted a positive association between board engagement in healthcare quality activities and healthcare outcomes. However, most research has been undertaken through surveys examining board engagement in a limited number of governance processes. This paper presents evidence of a comprehensive range of processes related to governing healthcare quality undertaken at the corporate governance level. This provides a more detailed picture than previously described of how corporate governance of healthcare quality is enacted by boards and management. METHODS: A comparative case study of eight Australian public hospitals was undertaken. Case studies varying is size and location were selected from two Australian states. Data collection included a review of key governance documentation, semi structured interviews with board members and senior management and an observation of a board quality committee meeting. Thematic analysis was undertaken to identify processes related to key tasks in governing healthcare quality. RESULTS: Two key tasks in the corporate governance of healthcare quality, evaluating healthcare quality and overseeing quality priorities, were examined. Numerous processes related to these two tasks were found. Case studies, while found to be similar in engagement on previously identified processes, were found to differ in engagement in these additional processes. While generally low levels of engagement in processes of overseeing quality priorities were found, cases differed markedly in their engagement in evaluating healthcare quality processes. Additional processes undertaken at some case studies represent innovative and mature responses to the need for effective corporate governance of healthcare quality. In addition, a group of processes, related to broader governance taskwork, were found to be important in enabling effective corporate governance of healthcare quality. CONCLUSION: The work of governing healthcare quality, undertaken at the corporate governance level, is redefined in terms of these more detailed processes. This paper highlights that it is how well these key tasks are undertaken that is important in effective governance. When processes related to key tasks are omitted, the rituals of governance may appear to be satisfied but the responsibility may not be met. Boards and managers need to differentiate between common approaches to governance and practices that enable the fulfilment of governance responsibilities. This study provides practical guidance in outlining processes for effective corporate governance of healthcare quality and highlights areas for further examination.


Assuntos
Conselho Diretor/organização & administração , Hospitais Públicos/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Austrália/epidemiologia , Estudos de Casos e Controles , Administração Hospitalar , Humanos , Qualidade da Assistência à Saúde/normas
11.
J Prof Nurs ; 35(5): 346-352, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31519336

RESUMO

The complexities of today's health care environment require organizational governing boards to have deeper understanding of health needs, influences, and outcomes with diverse board leadership. Nurses understand the complexities and demands of health care, but few nurses are engaged on boards of directors and many nurses feel unprepared for the governance leadership role. The nurse of the future requires governance knowledge and competencies to influence organizational policies that will improve health care outcomes and advance health promotion. Governance education is a necessary component of preparing the nurse of the future to influence health care transformation. Until nurses can confidently embrace governance leadership as a part of their professional identity, convincing and expecting non-nurse board leaders to appoint nurses to boards will continue to be a challenge. This paper describes a strategy for incorporating governance competencies into nursing curricula across all education levels by leveraging the American Hospital Association Governance Core Competencies (2009) and the Massachusetts Nurse of the Future Core Competencies©-RN (Massachusetts Department of Higher Education Nursing Initiative, 2016).


Assuntos
Conselho Diretor/organização & administração , Liderança , Enfermeiras Administradoras/organização & administração , Papel Profissional , Currículo , Educação em Enfermagem , Humanos
12.
Nurs Forum ; 54(4): 575-581, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31373014

RESUMO

In an environment in which there is little or no nursing presence on governing boards in healthcare organizations (HCOs), physicians, and nonclinicians take responsibility for keeping the other board members apprised of the quality of patient care, including nursing-generated, patient safety initiatives. Governing boards in HCOs are either not appointing nurses to governing boards or are not appointing nurses in numbers that are commensurate with the size and vital contributions of the profession. As a result, competent nursing professionals with an intimate understanding of quality care and patient safety are not in decision-making roles that may redesign health care and improve patient care. The purpose of this qualitative study was to describe experiences of nurse board members who hold governing board appointments in HCOs, and to describe the facilitators of and barriers to holding governing board appointments, as experienced by those nurse board members. This novel research employed naturalistic inquiry to explore the experiences of 12 nurse board members who held appointments with voting privileges in HCOs. From the interview data emerged four distinct themes: leveraging relationships and networking, valuing the mission of the board, feeling respected for my participation, and committing to board work. Facilitators of and barriers to governing board appointments were suggested. Findings validated the few previous research studies found in the literature and have implications for nursing leadership and governance.


Assuntos
Conselho Diretor/normas , Liderança , Papel do Profissional de Enfermagem/psicologia , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Conselho Diretor/tendências , Humanos , Segurança do Paciente/normas , Pesquisa Qualitativa
14.
J Health Organ Manag ; 33(4): 426-442, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31282818

RESUMO

PURPOSE: A key question in the provision of public health concerns how that provision is governed. The purpose of this paper is to examine the governance structure of a public health board and its perceived impact on the efficacy of clinical operations. DESIGN/METHODOLOGY/APPROACH: Structural issues examined the level of centralisation and public participation, and whether governance should occur through elected boards or appointed managers. These issues were examined through multiple lenses. First was the intention of the structure, examining the issues identified by parliament when the new structure was created. Second, the activities of the board were examined through an analysis of board meetings. Finally, hospital clinicians were surveyed through semi-structured interviews with both quantitative and qualitative questioning. FINDINGS: A contradiction was revealed between intention, perception and actual activities. This raises concerns over whether the public are significantly informed to elect the best-skilled appointees to governance positions. PRACTICAL IMPLICATIONS: This research holds implications for selecting governance structures of public health providers. ORIGINALITY/VALUE: Few studies have looked at the role of a publicly elected healthcare governance structure from the perspective of the clinicians. Hence, this study contributes to the literature on healthcare structure and its impact on clinical operations, by including a clinician's perspective. However, this paper goes beyond the survey and also considers the intention of the structure as proposed by parliament, and board activities or what the board actually does. This enables a comparison of intention with outcomes and perception of those outcomes.


Assuntos
Administração em Saúde Pública , Participação da Comunidade , Conselho Diretor/organização & administração , Processos Grupais , Humanos , Entrevistas como Assunto , Nova Zelândia
17.
Indian J Med Ethics ; 4(3): 254-255, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213416

RESUMO

The Government has superseded the Medical Council of India (MCI) with an interim board of governors that has assumed the powers and functions of the Council, pending passage of the National Medical Commission Bill. While a systemic revamp of medical education is intended, uncertainty prevails on whether medical academia will now be more inclusive.


Assuntos
Educação Médica/legislação & jurisprudência , Educação Médica/normas , Discriminação Social/ética , Discriminação Social/prevenção & controle , Conselho Diretor , Regulamentação Governamental , Humanos , Índia , Metáfora
18.
Am J Orthod Dentofacial Orthop ; 155(6): 749-751, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31153483
19.
Nurs Res ; 68(5): 405-412, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31045866

RESUMO

BACKGROUND: Healthy People 2020 has made achieving health equity one of its overarching goals; another goal is increasing the number of accredited local agencies that have Community Health Improvement Plans (CHIPs). Community Health Improvement Plans are meant to serve agencies as guiding documents for multiple years. OBJECTIVES: This study investigates the prevalence with which health disparities are addressed within CHIPs and the specific health disparities targeted by these objectives. METHODS: Researchers analyzed 4,094 objectives from CHIPs of 280 local Public Health Accreditation Board (PHAB)-accredited and nonaccredited public health agencies in the United States. RESULTS: Despite the PHAB's focus on addressing health equity, not all PHAB-accredited agencies addressed health disparities (85.4% of CHIPs analyzed). However, more accredited than nonaccredited agencies (73.9%) contained at least one objective focused on health disparities. DISCUSSION: Findings indicate that if health equity is truly a goal of national initiatives, agencies' planning documents (e.g., CHIPs) can do a better job addressing commonly ignored populations.


Assuntos
Planejamento em Saúde Comunitária , Equidade em Saúde/organização & administração , Disparidades nos Níveis de Saúde , Acreditação/estatística & dados numéricos , Feminino , Objetivos , Conselho Diretor , Programas Gente Saudável , Humanos , Masculino , Administração em Saúde Pública , Estados Unidos
20.
Creat Nurs ; 25(2): 82-86, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31085660

RESUMO

Nurses across the nation are stepping forward as leaders in response to the rapid and continuous change in health care and the acute needs of vulnerable populations. Caring for vulnerable populations is inherent in the nurse's role. However, caring for those in vulnerable states goes beyond the bedside. Nurses are in a unique position to bring their experiences and knowledge in patient care, quality, safety, cost containment, and wellness, as members of boards, elected officials, and nonprofit directors. Their impact is significant, as they balance critical thinking skills, financial knowledge, and compassion in order to influence executive decision-making. This article describes the importance of nurses serving on boards from evidence-based as well as personal perspectives, and presents specific examples of nurses' impact on vulnerable populations and those on the brink of vulnerability, in schools, communities, health-care institutions, and beyond. Will you also rise to the call to serve?


Assuntos
Empatia , Conselho Diretor , Papel do Profissional de Enfermagem/psicologia , Cuidados de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Defesa do Paciente/psicologia , Populações Vulneráveis/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados Unidos
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