Managed care credentialing of advanced practice nurses.

The enormous and rapid changes taking place in health care delivery are forcing institutions, organizations, and individual providers of care to reexamine their relationships and create new methods of assuring both quality of care and safety for consumers. One result has been the emphasis on systematic methods of credentialing, privileging, and measuring and evaluating an individual's qualifications and actual performance. This article discusses the credentialing and privileging processes that are either in place or evolving for physicians in the managed care health care systems. With the continued evolution of managed care in this country, advanced practice nurses may need to expand their credentialing process. This article provides information on the evolutionary events leading to credentialing and privileging, current and anticipated credentialing measures, sources of measurements, medicolegal issues, and suggestions for expansion of nurse credentialing. A comprehensive credentialing system will provide additional evidence of the nursing profession's capacity to play a major role in the reformed health care system.

Father involvement in infant care: two longitudinal studies.

Data collected from two samples of fathers in separate longitudinal studies were compared. One sample consisted of 53 first-time fathers and the other of 69 multiple-time fathers. A post-test only time-series design was used for both studies, and both employed the same procedures and instruments. The studies examined role enactment of fathers with different child-caring experiences using role-theory concepts. Fathers' normative expectations, personal expectations, and personal learning about parenting were tested to determine if they were predictive of paternal role performance. The findings seem to indicate that the culture of fatherhood has changed more rapidly than the conduct of fatherhood.

A comparison of fathers of high-risk newborns and fathers of healthy newborns.

Eighteen fathers of healthy newborns were matched and compared with 18 fathers of newborns with health problems at birth to determine if there is a relationship between the newborn's health status and paternal perceptions, behaviors, and adjustment to fatherhood. A series of questionnaires were administered during the newborn's hospitalization and at 1 and 3 months after discharge. Fathers of newborns with health problems performed significantly more infant care (p less than 0.005) behaviors and were found to have higher adjustment to parenthood scores (p less than 0.0381) 1 month after discharge than fathers of healthy newborns. No differences were found between the two groups 3 months after discharge.

Hospital-based home health care programs: a descriptive study.

The changing health care delivery systems have encouraged extension of inpatient services into the home. The authors' study provides a description of hospital-based home health programs among 312 central United States hospitals. Areas of focus are market segments, range of services, financial dimensions, and organizational features, implications for marketing and management are addressed.

Feasibility of screening young children in day care centers--a preliminary investigation.

A preliminary investigation of a method of providing health screening in day care centers was conducted. Ninety-four children, birth to 6 years, attending two day care centers were screened for health and developmental problems. A nurse trained day care staff to conduct the screenings, supervised their activities, rescreened children with questionable results, and conducted an interrater reliability study as well as referral and followup activities. The nurse also did assessments of environmental characteristics of the programs, their policies, procedures, and activities and assessed staff and parent information needs concerning child development, health practices, and health needs of children. Thirty-nine problems were identified in 33 children. Followups of 29 problems were completed, and 16 of these were verified. The 29 problems resulted in a total of 35 visits to primary health care providers. Among parents of children with verified problems, only three had been aware of the problem. The overreferral rate was 47 percent. Interrater percentages of agreement on most screenings were more than 80 percent. The findings suggested that the screenings were feasible with specific modifications. The screening activities were acceptable to parents, their physicians, and center staff. Centers were responsive to staff and parent needs identified in the screening process but not to recommendations for change within the environment and in operating procedures, partly because of fiscal implications. Screenings were adequate to identify a number of health problems prevalent in children under 6, and interrater reliabilities were acceptable.

Use of physician-hired nurses. A survey.

The results of a survey conducted on the practice of using physician-hired nurses in hospitals are reported. Nursing administrators need information on the nursing services that are being provided in direct association with the medical practice of physicians, particularly when those services influence the quality and cost-effectiveness of patient care. The information can be used to plan more effective approaches to the delivery of nursing health care services.

Redefinition of school nursing practice: integrating the developmentally disabled.

Results of three needs assessment studies which had the purpose of providing direction for school nursing practices which would address some of the unmet health needs of today's children and adolescents are reported. Results provide specific examples of how school nurses have not been meeting school health needs through an analysis of one specific need -- integrating the developmentally disabled into the regular school setting. Data were collected from parents, teachers and other supportive personnel in schools by interview and survey methods. Environmental assessments were conducted and the policies and procedures governing health-related activities required by special need students were reviewed. The data indicated that for developmentally disabled students, nurses were not performing the commonly accepted functions of nursing and were not transposing their knowledge of the components of health care ordinarily provided in health care settings to care provided in nontraditional health care settings. Examples of nursing functions and the activities needed to fulfill those functions are provided.

Drug-drug interactions among residents in homes for the elderly: a pilot study.

This pilot study investigated epidemiologically the potential for clinically significant drug-drug interactions, a subclass of adverse drug responses, in two homes for the elderly. The agent (drugs), host (residents), and environment (rural and urban nursing homes) in the illness known as drug-drug interaction were studied. Drug profiles on 188 subjects were compiled and screened by computer. Of these, 100 (80 in the rural home and 20 in the urban home) had the potential for clinically significant drug-drug interactions. Laboratory diagnostic procedures essential to confirm the unintentional interaction of two or more drugs were beyond the scope of the study; therefore, physicians independently reviewed the records of 66 residents who could be interviewed, agreeing that 27 residents were potential drug-drug interactors. These subjects had twice as many drug products and three times as many pro re nata products prescribed for them as did subjects without the potential for drug-drug interaction. The possible cause of interaction found most frequently was digitalis combined with thiazide or furosemide. The results of this pilot study suggest several implications for practice within the research setting.