Humanitarianism in surgery.

PURPOSE: Humanitarianism is by definition a moral of kindness, benevolence and sympathy extended to all human beings. In our view as surgeons working in underserved countries, humanitarianism means performing the best operation in the best possible circumstances with high income country (HIC) results and training in-country surgeons to do the same. Hernia Repair for the Underserved (HRFU), a not for profit organization, is developing a long term public health initiative for hernia surgery in Western Hemisphere countries. We report the progress of HRFUs methods to render humanitarian care. METHODS: In a collaborative effort, Creighton University and the Institute for Latin American Concern developed an outpatient surgery site for hernia surgery in Santiago, Dominican Republic. Based on this experience, we developed a sustainable care model by recruiting American and European Hernia Society expert surgeons, staff members they recommended, building relationships with local and industry partners, and selecting local surgeons to be trained in mesh hernioplasty. HRFU then extended the care model to other Western Hemisphere countries. RESULTS: Between 2004 and 2015, the HRFU elective hernia morbidity and mortality rates for 2052 hernia operations were 0.7 and 0%, respectively. This is consistent with outcomes from HICs and confirms the feasibility of a public health initiative based on the principles of the Preferential Option for the Poor. CONCLUSIONS: HRFU has recorded HIC morbidity and mortality rates for hernia surgery in low and middle income countries and has initiated a new surgical training model for sustainability of effect.

Free hernia surgery for the underserved is possible in the United States.

INTRODUCTION: Inguinal hernia is one of the most common ailments known to mankind. When symptomatic it can severely affect the patient's quality of life. Nevertheless, the vast majority of inguinal herniorrhaphies are elective and, therefore, not available to uninsured patients who do not have the financial wherewithal to pay for the operation. Using the Surgery on Sunday model developed in Kentucky, hernia repair for the underserved developed a free clinic for hernia surgery, based on institutional commitment to the poor as well as the volunteer efforts of medical students and hospital personnel at all levels. METHODS: After consulting with Surgery on Sunday personnel, HRFU determined the number of in need patients by consulting with local free clinic physicians. Second, and most time consuming, was the application for the Federal Tort Claims Act (FTCA) medical legal protection. Under this law, all in hospital credentialed volunteer professionals are medico-legally protected if the surgery is performed in an associated free clinic. After FTCA application re-writes and committee meetings to work out logistics of the pre-op clinic, the follow-up clinic, enlistment of other volunteers such as transporters, translators, housekeeping for the ORs, a pharmacist, registration personnel and creation of HRFU hospital forms we established a surgery date. A memorandum of understanding was drafted and an agreement letter with the hospital system was co-signed. Fourteen patients were seen in the pre-operative clinic and two were placed on waiting list. Patients were operated upon using 3 operating rooms and a volunteer staff of 4 surgeons, 4 anesthesia personnel and 13 nurses. RESULTS: No surgical complications were encountered intra-operatively or in the recovery room, and all patients were discharged by 2:30 p.m. 1 week post-operatively one patient had severe incisional pain, two had operative site swelling, but there was no evidence of infection or hematoma, and one had a distal sac fluid collection. All patients returned for follow-up and were appreciative of the care provided. The enthusiasm and participation of the patients and staff both pre-operatively, the day of surgery and postoperatively was outstanding. CONCLUSION: On the basis of this result HRFU is prepared to assist other US hernia specialists and their respective hospitals to make Surgery on Sunday a possibility in their community.

Enhancing career marketability through intrapreneurship.

Building a career of depth and breadth is lifelong work. While conscious forethought and planning is important, even more critical is the courage to take risks and to continually "push the envelope" in terms of skill development. Active intrapreneurs find opportunities to create change and innovation in their organizations and personally benefit from an increased repertoire of marketable skills. In today's health care environment, middle management and executive positions are being consolidated and even eliminated, making it more difficult for upward mobility in the organization. Intrapreneurship offers a way to develop marketable career skills and creates visibility for the individual.

Managerial partnerships. The wave of the future?

Although managerial partnerships are becoming more common in healthcare organizations, very little is available in the literature regarding a practical, concrete methodology for ensuring success of the relationship. The authors explore the nature of managerial partnerships and the perils and pitfalls of forming these relationships. Experiences from successful and failing partnerships will be used to identify the essential elements of healthy partnerships. Key steps and principles for creating a successful partnership are identified.

Teams 101: the manager's role.

Health care organizations that have reengineered or redesigned their structure have found teams to be a logical result of these initiatives. Teams make sense in today's world for many reasons: the increasing complexity of our work; the changing values of the workforce; the increasing need for immediate organizational response to difficult external marketplace changes and internal challenges; and our desire to create a healthy, satisfying workplace for employees. Managing teams is not like managing individuals. Nurse managers have the basic competencies necessary but need to recognize how the process may differ when the entity to be managed is a work team. This article explores the manager's role in developing and managing teams.

Team-based organizations: leading the essential transformation.

Transforming organizations into team-based structures is an intense professional challenge. What begins as a structural change will not be completed until the cultural transformation has occurred. This process challenges leadership skill and experience-based competencies. But, the opportunities for personal and organizational growth are phenomenal. Stay open to the process, continually question and analyze outcomes, and utilize new leadership competencies.

Cancer pain management in the hospice setting.

Pain relief for the cancer patient in the hospice setting is almost always achievable. Cancer pain is caused by tumor growth and by psychosocial and spiritual factors. Opioid drugs are the mainstay of effective treatment. Morphine is the opioid drug of choice. Although tolerance to opioids occurs, tumor growth is the usual reason for escalating opioid dose. Addiction almost never occurs in the cancer patient with pain. These patients don't exhibit drug-seeking behavior or experience the psychic high seen in drug addicts. Nonsteroidal anti-inflammatory drugs and adjuvant analgesics are synergistic with opioids in providing analgesia and allow lower opioid doses and fewer side effects. Ten to 15 percent of hospice patients will require regional anesthesia for pain relief. The hospice team of physicians, nurses, social workers, chaplains, aides, and volunteers is more effective than any single health care provider in achieving optimal pain relief and comfort.

Managing change: the leadership challenge of the 1990s.

The 1990s is being referred to as the "decade of transition." With a new millennium nearing, change today is faster and more complex than it has ever been before. Nursing leaders are being challenged as never before to not only cope with changes, both personally and professionally, but to effectively manage major changes within their areas of responsibility. This article will present a change developmental process model that is useful in managing departmental or organizational changes.

Chaos or transformation? Managing innovation.

Nurse innovation is the key to transformation of the healthcare organization and the healthcare system. This article offers the nurse executive and the leadership team a way to assess innovative tendencies of their department or organization and determine where strengths and trouble spots exist. The author discusses a five-phase innovation management process with suggested interventions for each phase.

Nurse intrapreneurs: the heroes of health care's future.

Innovation may be the key to cost-effective health care in the 1990s. Those institutions that can encourage nurses to become "intrapreneurs," or innovators, within the organization will hold an advantage as such encouragement fosters staff satisfaction and enhances productivity.

Managing temporary staffing services: selecting the right agency.

Hospitals frequently must resort to using temporary staffing agencies. As an informed client and skilled negotiator, the nurse executive can obtain the highest quality and best price possible.

The hospital based staffing agency.

Before a hospital considers creating an internal staffing agency, a detailed business plan must be developed. By addressing marketing and operational issues in advance, nurse executives can avoid unnecessary business problems.