Broader Health Care Community Research Articles

Using Effects-Based Reasoning to Examine the DNP as the Single Entry Degree for Advanced Practice Nursing

In October 2004 the American Association of Colleges of Nursing (AACN) endorsed the Doctor of Nursing Practice (DNP) as the single entry degree for advanced practice nurses (APNs) beginning in 2015. This action initiated significant changes in many graduate nursing programs. Currently 153 DNP programs have enrolled students and an additional 106 programs are in varying stages of development. This article will examine real and potential outcomes of having the DNP degree as the single entry level for APN practice using an effects-based-reasoning framework. The author begins with a discussion of factors that influenced the DNP initiative and an explanation of effects-based reasoning. Within an effects-based framework, the author examines acceptance or rejection of the DNP initiative by APN programs and professional organizations, as well as the effects within the broader healthcare community. Concluding observations will be shared.

Consensus Terminology for Stages of Care: Acute, Chronic, Recurrent, and Wellness

Objective As the chiropractic profession delineates its role in the emerging health care marketplace, it will become increasingly important that the scope of appropriate chiropractic care is clearly defined relative to overall patient case management. Therefore, the Council on Chiropractic Guidelines and Practice Parameters engaged in a multidisciplinary consensus process addressing the terminology related to “levels of care.” Methods A formal consensus process was conducted in early 2009, following the RAND/UCLA method for rating appropriateness. Panelists were selected to provide a broad representation of the profession in terms of geographic location and organizational affiliation, and an attempt was made to include members of other professions, including representation from third-party payors. The Delphi process was conducted electronically in January-February 2009. A nominal group panel was conducted through an online meeting service using an experienced group facilitator. Twenty-seven panelists were selected; all but 3 were doctors of chiropractic. Six of the panelists had experience as consultants with third-party payors. Results Fifteen seed statements were circulated to the Delphi panel. Consensus was reached on all statements after 3 Delphi rounds, with further refinements made through the nominal group panel. Conclusions By using a recognized formal consensus process, the Council on Chiropractic Guidelines and Practice Parameters has endeavored to establish a set of terms that are acceptable to the chiropractic community in order to facilitate their use within the broader health care community.

Turning the page on a New Chapter

In 1990, a new peer-reviewed journal was launched to focus on infectious diseases from a uniquely Canadian perspective. Initially coined The Canadian Journal of Infectious Diseases and renamed in May 2004 to The Canadian Journal of Infectious Diseases and Medical Microbiology to reflect its broader mandate, it is the official journal of the Association of Medical Microbiology and Infectious Diseases (AMMI) Canada. It took its place in the annals of history with its inaugural issue under the newly appointed Editor-in-Chief, Dr Lindsay Nicolle, of the University of Manitoba (Winnipeg, Manitoba). It has earned its position as a focal point for infectious diseases and medical microbiology in Canada over the first two decades of its publication through the continuous efforts of the Editor-in-Chief, Associate Editor-in-Chief, Associate and Section Editors, the Editorial Board and the publisher, Pulsus Group Inc, as outlined in the past issue (1). Indeed, the readership extends well beyond the disciplines of infectious diseases and microbiology, and has earned a loyal following throughout the broader health care community in Canada. We are deeply indebted to these early ‘pioneers’ of the Journal for bringing us forward to this point in time. It is worthwhile to remind the readership of the determination, courage and perseverance of Dr Nicolle, the Editors and the staff of Pulsus Group Inc for bringing us forward to where we are today. Breaking a new trail through a harsh new landscape is much more difficult than travelling the well-trodden path. The Journal has been indexed in EMBASE/Excerpta Medica and Current Contents since 1994, and PubMed (National Library of Medicine, National Institutes of Health [USA]), from 2000 onwards, and is recognized as the repository of scientific articles and editorials that are both unique and relevant to the Canadian perspective of infectious diseases and microbiology. With this issue, the page is turned on a new chapter in the annals of the history of the Journal. With my appointment as new Editor-in-Chief of the Journal beginning January 1, 2009, it is with great humility that I look back at the work that has been accomplished to date, bringing the Journal to its present state of success. The task that lies ahead is made that much easier by the solid foundation, organization and work ethic that has been laid by Dr Nicolle, Dr Embree and the other Associate and Section Editors. In the present issue, two new Section Editors are being introduced for the Adult Infectious Disease Notes and some of the terms of other Associate and Section Editors may be renewed or come to a close in the ensuing issues. It can be anticipated that other Associate or Section Editors may be appointed in the future as new directions are plotted for the Journal. In addition, this issue marks the introduction of ‘online’ only publishing of articles, which will increase our publication capacity. The future of the Journal has both opportunities and challenges in the current global fiscal environment in which we exist today. The fiscal pressures that global economies are currently facing are unprecedented since the Great Depression of the 1930s. Declining pharmaceutical and industrial revenues, declining value of endowments and other monetary funds, combined with a depressed retail market, are realities that many industries are facing. Nevertheless, with the new Web-enabled age in which we find ourselves, the ever-expanding repertoire and depth of search engines, the appreciation of making knowledge available in the public domain, and the initiation and expansion of open-access journals, the opportunities for the Journal to forge bold new trails through yet uncharted landscapes holds great promise.

A glance back in time: Two decades at the John W. Scott Health Sciences Library

This summer, the Health Sciences Library at the University of Alberta in Edmonton celebrates 20 years at its current location in the Walter C. Mackenzie Health Sciences Centre. Named for the Dean of Medicine from 1948 to 1959, the John W. Scott Health Sciences Library opened its doors to the public in early August 1984. Plans for the new library and health sciences centre went through numerous iterations from the mid 1960s until construction began in the late 1970s. Regardless of the library’s location, from the new facility back through its previous sites, staff members have always worked in partnership with the rest of the university library system and the broader healthcare community to provide innovative services to students, faculty, researchers, and clinicians in central and northern Alberta. Within the Canadian context, the University of Alberta ranks as an older institution since it opened in 1908. The first medical school class began studies in 1913, and the Department of Pharmacy, a “sub-faculty” of Dentistry, and the Alberta Research Council were all established within the next few years. The School of Nursing opened in 1924, and the School of Physiotherapy in 1954. The health sciences faculties now include Medicine and Dentistry, Nursing, Pharmacy, and Rehabilitation Medicine, each with a full range of undergraduate and graduate programs. The reading materials to support these programs were originally housed in the university’s only library in Athabasca Hall, one of the earliest multipurpose buildings on campus and still an architectural treasure. The collection moved into the new Arts Building a few years later, then into Rutherford Library when it opened in 1951. In 1963, the collection found a home in Cameron Library, which has primarily served the sciences since its opening. Although the Medical Library within Cameron served students, faculty, and clinicians well, as new teaching and research buildings were erected at the south end of campus around the University Hospital, users felt inconvenienced by the Cameron Library’s location. The number of books and photocopied articles delivered to the hospital reading room rose steadily. At the same time, medical faculty and University Hospital staff began to dream of a new specialist hospital that would provide greater opportunities for research and much needed new facilities for patient care. Enthusiasm for this specialist hospital, which on paper was named the Centennial Hospital, marked the first planning stage for a state-of-the-art health sciences centre, which would include an equally progressive health sciences library. In 1971, the Social Credit government in Alberta was defeated by Peter Lougheed’s Conservatives, who rejected the Centennial Hospital plans. Within a few years though, the young government commissioned and then endorsed a new plan for a university health sciences centre in Edmonton. While the faculty and staff at the University Hospital lacked enthusiasm for the vision expressed in the government-backed Clarkson Report, they worked within its constraints and won some modifications. Government approval to fund the health sciences centre loosely coincided with the establishment of the Alberta Heritage Foundation for Medical Research, marking a new era in health care and research in the province of Alberta. Phase 1 of the centre was to open in 1984 and include the new health sciences library. Bruce Peel, then Chief University Librarian, and Phyllis Russell, the Medical Librarian, planned extensively for the new library, basing decisions on careful research into user needs, publishing trends, and expected growth in teaching and research. They were originally allotted 20 000 square feet of space and successfully lobbied to increase that to more than 44 000 square feet. Around the time the library opened, it served an identifiable user population of about 4500 students, faculty, researchers, and clinicians in the city and beyond. Research funding for the health sciences faculties then amounted to a little more than CAN$3 million annually. As the library’s 20th anniversary approaches, the health sciences student body alone surpasses 4500, and external research funding in these faculties exceeds CAN$100 million. Eberhard Zeidler, well known for such landmarks as Canada Place in Vancouver and the Eaton Centre in Toronto, was chosen lead architect for the project. Zeidler integrated striking features typical of his style into both the Scott Library and the Mackenzie Health Sciences Centre as a whole. Lengthy skylights, massive glass ceilings, and extensive use of internal windows allow natural light to flow throughout the complex. Separate wings are joined on each floor by bridges marked by bright white railings, large round lanterns, and rows of potted plants. Atriums and courtyards fill the spaces between separate sections of the centre. The bright, airy, and open design suits Edmonton’s cold northern climate and vastly improves upon the early 20th-century hospital design it replaced.

P ERFORMANCE M EASUREMENTS IN E MERGENCY M EDICAL S ERVICES

With the strong encouragement of leading health care agencies, business principles are being implemented throughout health care, including emergency medical services (EMS). The reason is simple—quality of care can be enhanced by incorporating the management concepts of continuous quality improvement (CQI). The CQI process couples carefully identified, measurable performance indicators with information systems to monitor, analyze, and trend data. Benchmarking outcomes with other EMS systems allows the identification of “best practices” and the evolution of standards. Emergency medical services professionals must actively participate with the broader health care community in creating performance measurements to ensure that high-quality care is delivered consistently.