Cancer patients' satisfaction with communication, information and quality of care in a UK region.

Effective patient-professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. This study identifies patient satisfaction with regard to various aspects of communication and perceived quality of care. A well-validated questionnaire was administered to 435 cancer patients throughout Northern Ireland during a 3-month period. Northern Ireland can be regarded as a typical UK region in terms of cancer service configuration. The cohort consisted of patients with breast, colorectal, lung, prostate, gynaecological and gastric cancers. There was a 78% response rate. Satisfaction scores were individually calculated for various aspects of care, particularly diagnosis, treatment, follow-up and overall care. Non-parametric analysis examined the interaction between satisfaction scores and primary tumour site, age and gender. While overall satisfaction scores were relatively high, there was considerable variation. Of particular note was the interaction between perceived satisfaction and quality of care, communication, tumour site and age. Key findings are that there are a number of issues with regard to information and communication which can be clearly improved within Northern Ireland cancer services. The paper concludes that patient-professional communication should be tailored to meet individual need.

Academic leadership style predictors for nursing faculty job satisfaction in Taiwan.

The purpose of this study was to examine the influence of nursing deans' and nursing directors' transformational and transactional leadership styles on nursing faculty job satisfaction in baccalaureate and associate degree nursing programs in Taiwan. The study provides a mechanism by which nursing deans or nursing directors can obtain feedback from nursing faculty about leadership styles. Such feedback can then serve as the basis for further development of academic nursing leadership potential in Taiwan. The theory of transformational versus transactional leadership style guided this study. A cross-sectional mailed survey design was conducted. A convenience sample of 233 nursing faculty participated in this study. Idealized influence, intellectual stimulation, and contingent reward leadership styles significantly and positively predicted job satisfaction. However, active management-by-exception significantly and negatively predicted job satisfaction. Nursing leaders should implement effective leadership styles. Study implications for nursing education administration, limitations, and recommendations for future studies were discussed.

Navy medicine: a health care leadership blueprint for the future.

Health care organizations face unprecedented fiscal, regulatory, and social challenges. Future executive leadership of health care organizations must be extremely effective for an organization to remain vital. To identify the characteristics that successful leaders of the future will require, 11 senior health care executives in the U.S. Navy Medical Department were invited to describe (1) desirable characteristics of future health care leaders, (2) how to identify individuals with executive potential, and (3) how to prepare individuals to become successful health care executives. The findings provide a blueprint for leadership development for leaders in health care organizations.

Web-based courses. More than curriculum.

Online program development depends on an educationally and technologically sound curriculum supported by a solid infrastructure. Creation of a virtual environment through design of online registration and records, financial aid, orientation, advisement, resources, and evaluation and assessment provides students with access and program integrity.The planning of an academic support system as an electronic environment provides challenges and institutional issues requiring systematic analysis.

Research in the community hospital.

Research is an essential component in professional nursing practice. Although nursing research efforts have increased, there is little evidence of a consistent infrastructure within the community hospital to promote research utilization and the conduct of nursing research. There are multiple mechanisms for nurse administrators to support research efforts in the community hospital. We discuss the value of research and research utilization in the community hospital and suggest some practical strategies for nurse administrators to support research efforts.

Patients with operable oesophageal cancer: their experience of information-giving in a regional thoracic unit.

A qualitative descriptive study was developed to gain an insight into the experiences of patients with operable cancer of the oesophagus and the information they received. Through semistructured interviews, participants related details about different aspects of information-giving. Key sources of information were the consultant surgeon and other patients. Nurses, other medical staff, physiotherapists and dieticians were then mentioned. Family/friends were poor sources. Positive and negative aspects of the verbal and written information given were described, but there was minimal support for audiovisual information. Participants were given information relating to a number of key areas: treatment details, side-effects, extent of their disease, cure and prognosis and return to normality. A number of problem areas were identified. The findings indicate a need for a thoracic nurse specialist, updating of the information booklet and development of a staff education programme.

Emphasis courses: preparing baccalaureate students for transition to the workforce.

In response to identified needs for stronger preparation of baccalaureate graduates to enter the workforce, the University of Maryland School of Nursing created, implemented, and evaluated the use of Clinical Emphasis Seminars and Practicum. A sequence of 3 courses was ultimately developed for students to take during the final year of their upper-division nursing curriculum. The courses, totaling 5 credits, allow students to develop their knowledge and experience in a focus area within 1 specific type of clinical nursing. These courses follow up completion of required foundational clinical courses. Emphasis areas include all clinical areas offered within the nursing curriculum such as cardiovascular, critical care, and community health. Courses begin and end with 1-credit seminars and include one 3-credit clinical Practicum. In the latter course, students work with a clinical preceptor, following the preceptor's work hours for a minimum of 9 hours a week over the 15-week semester. Advantages of the Emphasis Courses are many: students develop an in-depth knowledge and clinical skills in a selected area of clinical practice. Potential employers have an opportunity to observe students in a preemployment setting and to evaluate the fit of skills and personal attributes to the specific setting. Students are provided with "value-added" knowledge and experience. The emphasis course model offers advantages to students transitioning into the workforce, to employers, and, ultimately, to clients served.

Nurse executives champion change in integrated health systems.

When facilities join integrated health systems, nurse executives must increase their focus on governance, staff education, financial analysis, mentorship, and planning to maintain strong patient advocacy across a continuum of care.

The relationship among medical diagnosis, nursing diagnosis, and nursing intervention and the implications for home health care.

The purpose of this study was to identify the most commonly used medical diagnoses, nursing diagnoses, and nursing interventions for home health care based on 244 patient records. Nursing interventions were categorized into three groups: assessment, instruction, and other. The results showed that for the three most commonly used medical diagnosis groups--"infectious and parasitic disease," "disease of the circulatory system," and "neoplasms"--the most related nursing diagnoses were "alteration in mobility," "alteration in cardiac status," and "alteration in comfort: pain." The most used nursing interventions were "instructions." The results indicated that nurses identified patients' physiological problems mostly in relation to medical diagnoses, and teaching was the most frequently used nursing intervention in home health care.

Analysis of patient profile in predicting home care resource utilization and outcomes.

OBJECTIVES: The study identifies patient profile variables that explain variation in resource utilization and outcomes for home healthcare. BACKGROUND: The healthcare reform and the demand for quality patient care have increased the need to identify key patient characteristics that can predict the use of resources and outcomes; however, home healthcare industry currently lacks adequate information collection to reflect these needs. This study explored both the resource use and care outcomes for nursing administrators in monitoring quality, resource distribution, and reimbursement policy decision making. METHOD: The conceptual framework is based on Donabedian's quality care elements (structure, process, and outcome) and Nursing Minimum Data Set. This is a retrospective descriptive study design in which 244 patient records and data were obtained from a home healthcare agency located in Washington, DC. A series of stepwise and discriminant analyses was conducted for data analysis. RESULTS: The findings indicated that the total number of nursing diagnoses and two specific nursing diagnoses (alteration in mobility and knowledge deficit in i.v. therapy) were strong predictors of overall resource use. Prognosis proved to be the strongest predictor of discharge outcomes. CONCLUSIONS/IMPLICATIONS: The results indicated that data related to nursing diagnoses and nursing interventions can provide valuable information in predicting resource use. Prognosis made by nursing judgment was also sensitive in predicting patient outcomes. These critical data elements should be included in describing home health patient characteristics and related resource utilization and care outcomes.

Vertical systems integration.

Healthcare organizations are vertically integrating into systems for operational, economic, and quality incentives. These system transformations require that the nurse executive assume new roles, responsibilities, and skills. The authors review the trends in system integration and discuss implications for nurse administrators based on literature and structured interviews with nurse executives who have experience in integrated systems or who are engaged in integrated system planing and development.

The importance of information giving for patients newly diagnosed with cancer: a review of the literature.

The importance of information giving has been recognized and promoted in political, ethical and professional arenas and this has ultimately resulted in the publication of a vast amount of literature relating to the subject. This literature review considers the functions of patient information and the factors influencing information seeking for patients who have been diagnosed with cancer. Methods of providing information are discussed and the nurse's role in information giving is examined. A number of core problems are highlighted in relation to information giving. These problems, and possible reasons for them, are subsequently critically analysed. Finally, the literature relating to information needs of patients with cancer is evaluated and five key needs identified.

Data privacy and confidentiality in the public arena.

Public policy debates concerning the collection of healthcare information for use as aggregate databases to underpin healthcare planning are growing increasingly rankerous. Provider concerns for future patient relationships and public fear of damages resulting from information disclosure are driving the development of data collection policy. Through a special Task Force, the State of Maryland has addressed these issues and developed policy recommendations specific to data collection and use.

Nurses' MEDLINE usage and research utilization.

This exploratory study in the field of nursing informatics examined the usage of information technology, namely on-line access to MEDLINE in clinical setting, by a convenience sample of 121 nurses from a large university hospital. A descriptive correlational design was used. Guided by the conceptual frameword of Nurse-Computer Interaction and based on variables set forth in the Theory of Reasoned Action, the study tested hypotheses regarding attitudinal and normative influences on reported use of on-line bibliographic retrieval systems. It was also hypothesized that using MEDLINE coild increase and improve nurses' adoption of nursing research findings. Multiple regression analyses were conducted on nurses' responses to survey questions to test hypotheses-that those who register more favorable attitudes towards nursing research would have a higher reported use of the MEDLINE system. Findings were significant and supported the hypothesis that nurses' attitudes towards research influenced MEDLINE usage. Findings also indicated that MEDLINE usage was significantly related to nurses' research utilization.

A model for case management of high cost Medicaid users.

The material presented reveals a unique solution to meeting the health care needs of a certain population. The State of Maryland through the Maryland Medicaid High Cost User Initiative uses nursing case management to decrease costs while providing quality care. The Center for Health Program Development and Management (CHPDM) manages the program and will be providing "enhanced" case management services to the identified high-cost users under the age of 65.

Administrative issues for use of nurse practitioners.

As nurse administrators increasingly use nurse practitioners in healthcare delivery systems to provide high-quality, more cost-effective care, they must recognize and take action on key practice issues--autonomy, title protection, admitting privileges, physician back-up, and reimbursement. Careful attention and action directed to enhancing nurse practitioner usefulness will increase the flexibility of nurse practitioner utilization within specific institutions and across a diverse network of healthcare delivery sites structured to provide continuity of care.

Nurse-computer performance. Considerations for the nurse administrator.

Regulatory reporting requirements and economic pressures to create a unified healthcare database are leading to the development of a fully computerized patient record. Nursing staff members will be responsible increasingly for using this technology, yet little is known about the interaction effect of staff characteristics and computer screen design on on-line accuracy and speed. In examining these issues, new considerations are raised for nurse administrators interested in facilitating staff use of clinical information systems.

Nurse-computer interaction: staff performance outcomes.

The purpose of this study was to examine the relationship of nurses' cognitive and demographic characteristics to their information retrieval speed, accuracy, and subjective screen satisfaction during on-line interactions with three different computer screens. One hundred ten randomly selected female clinical nurses interacted with computer screens of varying information densities. Age, spatial memory, and spatial visualization were significant predictors for nurses' practiced and overall performance speeds. Age was an important variable across screens; the cognitive variables, however, differed according to screen types. Age was a predictor of nurses' practiced accuracy, while both age and spatial visualization predicted overall accuracy scores. Perceptual speed was not a significant predictor in any equations, and none of the nurse characteristics predicted subjective screen satisfaction.

The hyponatremia of neonatal urinary ascites: clinical observations, experimental confirmation and proposed mechanism.

A case of neonatal urinary ascites with severe hyponatremia is reported. Critical review of the literature on neonatal urinary ascites, which included determination of serum electrolytes, revealed a 70% incidence of hyponatremia. In an attempt to explain the mechanism of the hyponatremia, urinary ascites was produced in rats by creation of either a unilateral (uretero-peritoneal) or bilateral (vesicoperitoneal) shunt. Hyponatremia did not occur in the unilateral group but it was profound in the bilateral group. At 48 hours postoperatively renin was unchanged in the unilateral group but it was significantly elevated in the bilateral group. Aldosterone was elevated in the unilateral group and markedly elevated in the bilateral group. Urine entering the peritoneal cavity equilibrates with plasma. The proposed mechanism of hyponatremia in the bilateral group is autodialysis with intraperitoneal urine containing progressively lower sodium concentration secondary to increased renin and aldosterone.