The use of medical emergency teams in medical and surgical patients: impact of patient, nurse and organisational characteristics.

Medical emergency teams (METs) were developed to respond more rapidly to changes in patient condition. While effective, METs do not address events prior to the response. This study examined differences in patient, nurse, and organisational characteristics for 108 MET calls on five medical and five surgical units in a university hospital. MET calls occurred more often on the day shift (p = 0.007) for medical (p = 0.036), but not surgical, patients. Of the 108 events, 44% were delayed, defined as events with documented evidence that pre-established criteria for a MET call were present for >30 min. More delays occurred on the night shift (p = 0.012). Delayed events were not related to the number of patients assigned (p = 0.608). However, there was a trend for more delays when more patients were assigned (4:1 = 21% vs 6:1 = 43%). In a logistic regression model, shift and patient-unit-match (medical, surgical) were significant predictors of delays. The model correctly predicted 68% of delayed events. Study findings indicate that a combination of patient, nurse and organisational characteristics influence timely rescue.

Developing a multi-institutional nursing report card.

As regulatory and public interest groups demand information on the quality of patient care outcomes produced by their hospitals and care providers, nurse administrators are establishing processes for the effective and efficient definition, retrieval, and reporting of patient outcomes thought to be nursing-sensitive. The authors describe the administrative infrastructure and the data management processes used by one large integrated healthcare system to establish a nursing report card and maintain it for several years.

Vision 2000: the transformation of professional practice.

This century has seen miraculous advances in health care. Despite all our progress, however, there are some serious flaws in today's health care systems that demand our attention. This article describes the approach our integrated delivery system has taken to meet this challenge through implementation of the Transformational Model for Professional Practice, and the outcomes we have achieved.

Activity of cellulolytic enzymes in the contents of reticulorumen and caecocolon of roe deer (Capreolus capreolus).

Selective ruminants, which prefer easily digestible plants, cannot digest fibrous forage as well as grass eaters. Low enzyme activity or short retention time of ingesta particles in fermentation chambers appeared to be responsible for reduced cellulose breakdown. Seasonal activity of cellulolytic enzymes, cellulose concentration and protozoa population in reticulorumen (RR) and caecocolon (CC) of roe deer as a typical concentrate selector were investigated. Cellulase activities were lowest in winter when cellulose concentration in RR contents were highest. Highest enzyme activities and lowest cellulose concentration were measured in early spring. Cellulolytic activities were significantly correlated with the number of protozoa in RR. Only one entodinomorphic genus was identified in the RR. The enzyme activities in CC were far lower compared with those in RR. Low cellulose digestion in the RR cannot be compensated for by cellulose breakdown in the CC. The reduced cellulose digestion of roe deer may be attributed to the short retention time of food particles in spring and summer, whereas decreased colonisation of microorganisms in the rumen may be the main reason for low cellulose breakdown in winter.

Project Wildfish: rewarding through innovation.

The appropriateness of a reward system depends, in part, on the developmental level of the staff. Based on a model developed at Shadyside Hospital, Pittsburgh, PA, called the Transformational Model for the Practice of Professional Nursing, we have determined that the potential for innovation becomes a highly valued reward for a healthy, well-developed nursing unit. Project Wildfish illustrates the energy, commitment, and enthusiasm that innovation can inspire.

A transformational model for the practice of professional nursing. Part 2, Implementation of the model.

Our healthcare system is undergoing major transformation. Most nurse executives are convinced that change is necessary and inevitable, but they are less certain how to position their departments for future success. The Transformational Model for the Practice of Professional Nursing was developed as a "road map" for that purpose. Part 1 (JONA, April 1994) discussed the professional practice paradigm shifts that are needed for future success. The model components were presented and applications identified. Part 2 discusses the implementation of this model in a practice setting.

A transformational model for the practice of professional nursing. Part 1, The model.

Our healthcare system is undergoing major transformation. Most nurse executives know that change is necessary and inevitable, but are less certain how to position their departments for these changes. The Transformational Model for the Practice of Professional Nursing was developed as a "road map" for that purpose. Part 1 of the model discusses the paradigm shifts that need to occur in professional practice for future success. The various components of the model are presented, and applications are identified. Part 2 will appear in the May 1994 issue of JONA, and will discuss the implementation of this model into a practice setting.

Transformational leadership in nursing service. A test of theory.

What are the leadership dimensions that result in low turnover or work satisfaction? Intellectual stimulation, charisma, and individual consideration constitute aspects of transformational leadership that are suggested to enhance retention and staff satisfaction. In this study, the authors tested transformational leadership theory in one nursing department with an executive, 11 midlevel administrators, and 77 staff registered nurses. Findings support the predictions. Composed of teachable components, transformational factors are similar to leadership qualities described in magnet hospitals, offering positive implications for nursing administration and professional nursing practice.

Executive seduction.

The growth of corporate orientation for healthcare structures, with a focus on bottom-line management, has radically altered the role of nurse executives. With the organization's emphasis on performance, productivity, and results, successful nurse executives are now integrating the management of the delivery of nursing care with the management of complex corporate structures and relationships. The editor of Executive Development discusses the rapidly changing expectations and demands of the contemporary nurse executive's work.

Clinical nurse specialists: the second generation.

The growth of corporate orientation for health care structures, with a focus on bottom-line management, has radically altered the role of nurse executives. With the organization's emphasis on performance, productivity, and results, successful nurse executives are now integrating the management of the delivery of nursing care with the management of complex corporate structures and relationships. The editor of Executive Development discusses the rapidly changing expectations and demands of the contemporary nurse executive's work.

Negotiating care.

The growth of corporate orientation for health care structures, with a focus on bottom-line management, has radically altered the role of nurse executives. With the organizations's emphasis on performance, productivity, and results, successful nurse executives are now integrating the management of the delivery of nursing care with the management of complex corporate structures and relationships. The editor of Executive Development discusses the rapidly changing expectations and demands of the contemporary nurse executive's work.

Primary nursing. The impact on nursing costs within DRGs.

This study compares direct nursing care costs within specific DRGs between a primary and team nursing unit. Using a computerized information system, data relating to length of stay, acuity, and nursing care costs were collected. The data revealed that, despite an increased acuity of 28%, a daily savings of $1.30 per patient per average DRG was realized by the primary nursing unit.