Nurse Coordinator Research Articles

Does transition theory matter? A descriptive study of a transition program in Australia based on Duchscher’s Stages of Transition Theory and Transition Shock Model.

Objective: Explore the impact of transition program policy directives grounded in foundational elements of transition theory. Background: Within fast-track health service environments nurse leaders remain committed to improving transition programs that support wellbeing and retain new graduate nurses. Duchscher’s Stages of Transition Theory and Transition Shock model was the framework chosen by the health service nurse leaders to implement in the clinical environment, however, implementing elements can be problematic without sufficient support and clear policy directives. Study Design and methods: Descriptive study using multiple methods in one major national health service that incorporates a number of private (eight) and public (four) hospitals across Australia. Online surveys were distributed to new graduate nurses at one, five and eleven months into the initial transition year. The survey tool was a synthesised adaptation of the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework. At the end of the transition year telephone interviews were conducted with the Nurse Managers who were responsible for implementing transition programs policies and processes. Resulting data were summarised using descriptive statistics for quantitative data and a thematic analysis for qualitative data. Results: 158 new graduate nurses returned the online survey and eight Nurse Managers participated in the telephone interviews. As a whole the new graduate registered nurses described feeling accepted during their transition and expressed feeling comfortable when approaching senior staff. They managed challenges of shift work and took time for self-care. The clear majority (88%) of participants reported no plans to leave the profession. Nurse Managers were able, in most clinical areas, to apply transition program policy and directives and enable the implementation of Duchscher’s Stages of Transition as the framework for the transition support initiatives. Retention of new graduates on their wards at the end of the program was determined to be a positive outcome for Nurse Managers. Discussion: A carefully structured Graduate Nurse Transition Program founded on sound theoretically grounded ideology alongside integrated policy directives guided the Nurse Managers implementation of Duchscher’s Stages of Transition Theory and Transition Shock model into practice. Additionally, a dedicated Graduate Nurse Coordinator role with a manageable ratio of graduate nurses was an important component included in the transition program at each participating hospital as it facilitated support of both graduates and Nurse Managers. These positions should be costed into any Graduate Nurse Transition Program. An interesting finding was the consistency in smaller units that were unable to provide or mobilise preceptors for the required allocated mirrored shifts and it was felt this workload management issue impacted the success of graduate transition nurse programs on those units. Conclusions: Implementing policy directives grounded in foundational elements of Duchscher’s Stages of Transition theory and Transition Shock model delivered consistent experiences for new graduate nurses across one major health service that incorporates a number of hospitals across Australia. Data suggested some practical challenges to program implementation for Nurse Managers, including unit/ward size, staffing, and varying levels of understanding of preceptor roles. Implications for research, policy, practice: Introducing formal policy directives that are grounded in strong theoretical frameworks of professional role transition, agreed to and funded by health service nurse leaders are important in guiding a consistent approach across health services in the implementation of evidence-based Graduate Nurse Transition Programs. What is already known about the topic? Duchscher’s foundational research on the Stages of Transition theory and Transition Shock model is applied to inform Graduate Nurse Transition Programs on an international level. There is a current workforce shortage within Australia and internationally. The importance of retention of newly graduated nurses has become a focus for health care services implementing supportive transition programs to prevent new graduates from leaving the profession in the first year. What this paper adds The inclusion of specific policy directives based on Duchscher’s Stages of Transition theory and Transition Shock model provides clear direction to Nurse Managers related to the required implementation steps and time frames to be met during the transition year. Additional Graduate Nurse Coordinator positions, with a manageable ratio of New Graduate Registered Nurses (NGRNs), are important supports for both graduates and Nursing Managers to meet policy directives. Additional positions should be costed within transition programs. Provides additional evidence that well supported newly graduated nurses are likely to remain within the health service.

Real-world implementation of an EHR-integrated, SMS text remote patient monitoring platform at an academic cancer center.

e13669 Background: Remote monitoring studies in oncology have shown improved quality of life, decreased healthcare utilization, and even improved overall survival in an oncologic population, however applications in a real-world setting have been limited. Barriers to successful deployment include low patient engagement rates with smartphone apps, lack of integration with the EHR and burdensome clinical workflows for staff. Methods: We sought to assess the feasibility of an EHR-integrated, SMS text conversational AI agent to automate the collection of ePRO data as well as the assessment and triage of common patient symptoms for patients with GI and GU tumors receiving anti-cancer therapy. This program was developed collaboratively by a health system digital health team, nursing informatics, IT support resources, oncology nurses, medical oncologists, and representatives from Memora Health. Core components included 1) weekly ePRO collection based on the NIH’s CTCAE, 2) NLP activated symptom triage for 16 common symptoms and toxicities 3) weekly symptom check-in 4) weekly medication adherence assessment for patients on oral therapy. Patients received all messages through SMS on their phones, and all data collected were routed into the EHR. In-EHR visualizations allowed nurse coordinators to track ePRO symptoms over time and symptoms that met pre-specified criteria triggered EHR-based alerts. Results: Of 99 patients ordered into this SMS program, 83 enrolled (84% enrollment rate), with 55 Uro Onc patients; 44 GI Onc patients. A total of 2,583 surveys were sent to patients. 98% of patients completed at least 1 survey. Overall patient survey completion rate was 62%. Medication adherence surveys had the highest completion rate at 81%. ePRO completion rates were higher for GU (65%) vs GI (39%) patients (p<0.01). 71% of ePRO surveys generated a symptom alert to the nursing staff. Patient satisfaction was high with 93% rating this SMS program as “excellent” or “good” (n=78). Care team surveys found that 3 of the 6 Oncologists believe ePRO collection is valuable and 3 of 6 used ePRO data to adjust a care plan. Nurse coordinators had a mixed view of the program with a majority reporting that there were too many symptom alerts. Conclusions: We successfully deployed an EHR-integrated SMS program to collect ePRO data, track patient symptoms, and monitor adherence to oral therapy. We believe having a physician champion influenced patient engagement in the GU patient population. Patients had a favorable impression of this program and survey completion rates demonstrated ease of use for patients. Clinical staff, particularly nurses, felt that there were too many alerts. Additional workflow changes may reduce alert burden and better incorporate ePRO learnings into clinical practice.

Sickle Cell Nurse Coordinators Bridging the Gap for the Future

Sickle Cell Nurse Coordinators Bridging the Gap for the Future

Communication of Incidental Imaging Findings on Inpatient Discharge Summaries After Implementation of Electronic Health Record Notification System.

Inadequate follow-up of incidental imaging findings (IIFs) can result in poor patient outcomes, patient dissatisfaction, and provider malpractice. At our institution, radiologists flag IIFs during report dictation to trigger electronic health record (EHR) notifications to providers and patients. Nurse coordinators directly contact patients or their primary care physicians (PCPs) regarding IIFs if follow-up is not completed within the recommended time frame. Despite these interventions, many patients and their PCPs remain unaware of IIFs. In an effort to improve awareness of IIFs, we aim to investigate communication of IIFs on inpatient discharge summaries after implementation of our EHR notification system. Inpatient records with IIFs from 2018 to 2021 were retrospectively reviewed to determine type of IIFs, follow-up recommendations, and mention of IIFs on discharge summaries. Nurse coordinators spoke to patients and providers to determine their awareness of IIFs. Incidental imaging findings were reported in 51% of discharge summaries (711/1383). When nurse coordinators called patients and PCPs regarding IIFs at the time follow-up was due, the patients and PCPs were aware of 79% of IIFs (1096/1383). With implementation of EHR notifications to providers regarding IIFs, IIFs were included in 51% of discharge summaries. Lack of inclusion of IIFs on discharge summaries could be related to transitions of care within hospitalization, provider alert fatigue, and many diagnostic testing results to distill. These findings demonstrate the need to improve communication of IIFs, possibly via automating mention of IIFs on discharge summaries, and the need for care coordinators to follow up on IIFs.

Nurse coordinators and IPAs in Parkinson's expert centers: what are their roles?

The creation of Parkinson's expert centers (PEC) led to the emergence of new nurses, known as coordination nurses. And in 2018, the emergence of advanced practice nursing led to the creation of a new category of professionals, advanced practice nurses (APN). Nurses coordinators and APN play a major role in meeting the public health challenges posed by Parkinson's disease. They are the guarantors of the implementation of a personalized care pathway, the aim of which is to offer patients an optimized quality of life. They forge an indispensable link between the city's healthcare services and the PEC, collaborating with the many healthcare professionals who work with people suffering from Parkinson's disease.

The development and evaluation of a short-term international student research and educational program

ObjectivesThis study aimed to describe the “how-to” details and processes for developing and evaluating a short-term international student research and education program. MethodsThis study included two parts: development and implementation, and evaluation of the program. A foreign doctoral nursing student requested to visit the West Virginia University School of Nursing for research training and academic teaching experience. The global nursing program coordinator and the lead mentor met and identified the program basis and team participants. Learning activities were related to this student’s interest in older adults and in-home end-of-life care, included four contents: research; educational engagement; practice/clinical engagement; special activities & professional development training and courses. The program evaluation was conducted at the end of the six-month visit using a focus group and an anonymous short survey. Participants (n = 10) included the host university’s faculty, graduate students, and one short-term international student. ResultsContent analysis of the participant’s short survey answers and the focus group discussion resulted in three themes: 1) lessons learned from participating in the program (enhanced diversity in education and research, gaining new global healthcare knowledge, and self-reflection on and promoting cultural awareness); 2) program barriers and challenges (the visa application process, the English language barrier, the lack of public transportation in the town, and scheduling conflicts); and 3) strategies to overcome these barriers and challenges (adding cultural diversity information into curriculum; attending English proficiency with others in the class; using different communication techniques; continuous collaboration with the University’s Office of Global Affairs for the Visa application process; providing interactive experiences). All participants rated their engagement in the program as very satisfactory (Mean = 4.67, SD = 0.50), and highly impacted their nursing skills in research, teaching, and clinical practice (Mean = 4.67, SD = 0.50). ConclusionsAll the participants have gained some experience in this program, which can be used for future teaching guidance. Further, international nursing students need assistance to adjust and thrive in the host university learning community. Faculty must be culturally sensitive, understand the visiting foreign nursing student’ learning needs, and advocate for an environment suitable for enhancing the students’ learning.

The Effect of Collaboration Between the ERAS Nurse Coordinator and ERAS Data Analyst

The Effect of Collaboration Between the ERAS Nurse Coordinator and ERAS Data Analyst

Relationship between the Role of Nurse Coordinator and Nurse Performance at Ujoh Bilang Health Cente

The nurse coordinator is a manager who is directly related to nursing care activities and nursing management. Purpose This research was conducted to determine the relationship between the role of the nurse coordinator and the performance of nurses at the puskesmas. This type of quantitative research with a descriptive correlation research design using a cross sectional approach. The results of the research on the role of nurse coordinator based on this study showed a good planning role of 93.5%, an organizing role of 51.6%, a directing role good by 87.1%, and a good supervisory role by 77.4%. The results of the analysis of the relationship between the role of the nurse coordinator and the performance of nurses obtained a p value of 0.015 (p <0.05). The conclusion of this study is that the role of a good nurse coordinator can improve the performance of nurses at the puskesmas.

Evaluation of the Cardiology Clinical Nurse Coordinator’s Role in Streamlining Patients for Cardiology Admission

Evaluation of the Cardiology Clinical Nurse Coordinator’s Role in Streamlining Patients for Cardiology Admission

Revenue and Cost Analysis of a System Utilizing Natural Language Processing and a Nurse Coordinator for Radiology Follow-up Recommendations

Radiology reports often contain recommendations for follow-up imaging, Provider adherence to these radiology recommendations can be incomplete, which may result in patient harm, lost revenue, or litigation. This study sought to perform a revenue assessment of a hybrid natural language processing (NLP) and human follow-up system. Reports generated from January 2020 to April 2021 that were indexed as overdue from follow-up recommendations by mPower Follow-Up Recommendation Algorithm (Nuance Communications Inc., Burlington, MA), were assessed for follow up and revenue. Follow-up exams completed because of the hybrid system were tabulated and given revenue amounts based on Medicare national reimbursement rates. These rates were then summated. A total of n =3011 patients were flagged via the mPower algorithm as having not received a timely follow-up indicated for procedure. Of these, n=427 required the quality nurse to contact their healthcare provider to place orders. The follow-up imaging of these patients accounted for $62,937.66 of revenue. This revenue was calculated as higher than personnel cost (based on national average quality and safety nurse salary and time allotted on follow-ups). Our results indicate that a hybrid human-artificial intelligence follow-up system can be profitable, while potentially adding to patient safety. Our revenue figure likely significantly underestimates the true revenue obtained at our institution. This was due to the use of Medicare national reimbursement rates to calculate revenue, for the purposes of generalizability.

Are Nurse Coordinators Really Performing Coordination Pathway Activities? A Comparative Analysis of Case Studies in Oncology.

Patient Pathway Coordination (PPC) improves patient care quality and safety, particularly in oncology. PPC roles, such as nurse coordinators (NCs), have positively impacted the quality of patient care and reduced financial costs. However, NCs and their real activities in Health Care Organizations (HCOs) are unclear. Our aim was to identify, quantify, and compare all activities performed by NCs in oncology care settings from an organizational approach. Methods: We used qualitative and quantitative approaches based on case study principles. We accumulated 325 observation hours by shadowing and timing the activities of 14 NCs in four French HCO in oncology. Data analysis was conducted using an analytical framework to investigate the Activity of PAtient PAthway Nurse Coordinators in Oncology (APANCO). Results: Our research generated important findings: (1) NC roles and job titles are not standardized. (2) Non-coordination related activities are important in NC work content. Non-coordination times were consistent with distribution times between ward NCs and NCs in centralized structures. Ward NCs had higher non-coordination activities when compared with NCs in centralized structures. (3) PPC times varied for both ward NCs and NCs in centralized structures. Ward NCs performed less design coordination when compared with NCs in centralized structures, and this latter group also performed more external coordination than ward NCs. Conclusions: NCs do not just perform PPC activities. Their position in HCO structures, wards, or centralized structures, influence their work content. Centralized structures allow NCs to focus on their PPC roles. We also highlight different dimensions of NC work and training requirements. Our study could help managers and decision-makers develop PPC roles in oncology.

Understanding the activity of oncology nurse coordinators: An elaboration of a framework based on an abductive approach

Care coordination is a major health system issue, in particular for cancer patients where a lack of coordination may impact quality of care, lived experiences, and care costs. Consequently, new roles facilitating Patient Pathway Coordination (PPC) have been created (nurse coordinators, NC). However, despite their importance, core PPC activities remain unclear. Practices are often heterogeneous and may be far removed from coordination roles, thus posing issues for implementation of PPC policies.To address this, we generated an analytical framework to investigate the Activity of PAtient PAthway Nurse Coordinators in Oncology (APANCO) from an organizational perspective. We adopted an abductive approach, characterized by two phases: the first involved a preliminary theoretical framework confronted with empirical data from two ethnographic fieldwork scenarios. In the second, we confronted the updated framework with data from a care coordination literature review.The final APANCO framework comprised three main categories at micro-level and three at meso-level. The first categories were used to analyze real NC activity at the micro-level and accounted for activities related (or not) to PPC. Meso-level categories considered organizational contexts that might have influenced NC work content.APANCO provided invaluable information on NCs activities. The framework may be used for clinical and managerial skills training and for standardizing job descriptions. These elements are key for decision-makers and managers who implement PPC programs.

Initiation and Implementation of Infusional Chemotherapy As a Base Regimen for Increased Risk Lymphoid Malignancy in an Inner-City Academic Institution

Our institution is a 695-bed facility that serves an inner-city population and the surrounding area which together are largely urban and have withstood longstanding obstacles to care including food insecurity, absence of reliable transportation, lack of insurance coverage, and poor health literacy. Such barriers have historically served to limit for many patients, routine outpatient visits, weekly, or even nadir lab work as well as outpatient-based cancer therapy. Institutional barriers include limited nursing resources. Given these challenges, with a change in divisional leadership and the establishment of a new fellowship in hematology/oncology, a simplified and streamlined approach to managing and treating high-risk lymphoid malignancies was planned. Infusional chemotherapy has been shown to have activity in a variety of lymphoid cancers (Wilson, 1993; Dobashi, 1998; Cassaday, 2018). To address inconsistent patient follow-up, a program was instituted, utilizing a dedicated Registered Nurse coordinator making routine proactive phone and electronic check-ins to ascertain patient status; a distinct, direct phone number to call to report symptoms; electronic medical record access for communication; dedicated physician/physician assistant availability; and treatment planning assigned to a single, designated faculty physician with fellow support. Additionally, planned treatment needed inpatient administration, no routine dose alterations, no requirement for patient self-medication, and scheduled single-dose growth factor support. With this in mind, we have utilized an infusional chemotherapy regimen of Hydroxydaunorubicin (Adriamycin) (10 mg/m2), OncovinR (Vincristine) (0.4 mg/m2), and Etoposide (50 mg/m2) by continuous infusion daily for 4 days with Prednisolone 125 mg IV daily for 5 days, and Cyclophosphamide 750 mg/m2 IV on day 5. Peg-filgastrim 6 mg subcutaneously was given following completion of therapy. Cycles were repeated every 21 days. Additions of Rituximab and TKI varied by individual malignancy type. Pt characteristics: 7 males/6 females, median age-45 (range: 19-75), median ECOG status-2, B symptoms-8, LDH elevation-9, no prior therapy-7, disease types: diffuse large B-cell lymphoma-4, large cell unclassifiable, intermediate between DLBCL and classical Hodgkin-2, plasmablastic lymphoma-1, primary effusion lymphoma-1, Burkitt lymphoma-1, lymphoblastic lymphoma-1, acute lymphoblastic leukemia-3.Median number of cycles received = 6 (range: 1-8).Six have had complete responses and four partial responses. One patient with acute lymphoblastic leukemia has undergone transplant and is free of leukemia at 19.9+ months. The median duration of complete response has not been reached at > 6 months. Median survival is ongoing at 11.5+ months. There have been no treatment-related deaths. Three patients required dose modification of Vincristine related to transient paresthesia. There have been no hospitalizations related to toxicity. This systematic approach including an infusional chemotherapy regimen may produce positive downstream effects such as consistency with nursing, a deeper understanding of side effects by nurses and mid-level providers and a predictable patient flow to improve the patient experience and ultimately outcomes. Given the resource constraints experienced at our institution, and potentially other urban teaching institutions, this approach may prove helpful in terms of patient compliance, satisfaction with care, and outcomes.

Abstract 11918: Improving Quality of Care for Patients With Valvular Heart Disease in a Learning Health System

Introduction: Delayed treatment of valvular heart disease (VHD) is associated with higher mortality and adverse event incidence. In a large, integrated health system, we developed and piloted a digital health solution embedded in the electronic health record (EHR) to identify, triage, and streamline evaluation of patients with VHD. Methods: The initiative began May 2021 with agreement of our team members and stakeholders for prioritization of the project and implementation. Structured echocardiographic data were made available in electronic data warehouse. SQL-based disease classification algorithms based on published guidelines were built for aortic stenosis (AS), mitral regurgitation (MR) and tricuspid regurgitation. Echocardiograms with suspected VHD were pushed daily into a reporting dashboard and smartform we built within the EHR. Nurse coordinators responsible for VHD patient care tested the platform, and we iteratively adapted components based on feedback. Performance of AS and MR classification algorithms against historical data were evaluated using kappa statistics. We launched the program in March 2022 and report the initial results. Results: Between August and October 2021, 650 echocardiograms were reviewed by a nurse coordinator. Agreement between the guideline-based algorithms and chart review was moderately high (0.64 for AS and 0.86 for MR). Between March and May 2022, 7180 echocardiograms with suspected VHD were surfaced in the EHR for 6588 patients. Among 1501 patients prioritized for review based on disease severity, 341 patients were referred to the valve clinic for procedural intervention, 783 patients are under watchful waiting, and 377 patients were determined to unlikely benefit from valve interventions. Conclusions: By leveraging data from echocardiogram repositories, it is feasible to implement a VHD quality improvement program within a learning health system. This requires a diverse and interdisciplinary team for development, implementation, governance, and continued iteration of EHR-embedded digital health tools to improve quality of care. While we focused on VHD, our methodology and infrastructure allow for expansion and leverage into other therapeutic domains within cardiovascular disease and beyond.

Nurse coordinator of care as a facilitator of integration processes in palliative care.

This paper investigates the feasibility and the perception of the nurse's role as the palliative care coordinator. Integrated care is a global imperative in all healthcare improvement processes. Due to Andrija Štampar's success in the organisation of public health services, Croatia today has more than hundred years of experience in care integration. The palliative care system has been continuously developing since 2014 as an integrated care model, with nurses as care coordinators. The study used a mixed methodology based on pragmatic research principles, including an analysis of strategic and policy documents and reports, and thematic analysis of focus group conducted with palliative care coordinators, following COREQ checklist. Although a legal, professional and financial regulation of nurse coordinators has been achieved, a number of implementation challenges remain. These challenges arise as a result of long-term fragmentation of the health and social care, and can be found in both horizontal and vertical integration of care, that is in the dimensions of functional, clinical, cultural and social integration. Nurses play a central role in care coordination. Coordination and integration promote professionalisation with clear roles and tasks. However, even with the legal, professional and financial implementation of the nurse coordinator model, it has to be further promoted as an equally important job in the healthcare system, with nurses as competent professionals in charge of care coordination. Palliative care provides a range of individualised, coordinated services that meet the medical and non-medical needs of seriously ill patients. Described model of palliative care in Croatia is particularly important because it was developed as an integrated part of health care (and partly social welfare) system, indicating with the nurse's role as palliative care coordinator that coordination is a continuous process that requires a dedicated professional role.

A novel nurse-coordinated home care model for palliative care in advanced cancer: A pilot interventional study from suburban Mumbai

Background: Demand for home-based health care services has increased considerably in India. Traditionally, home-based care services are physician-led which puts pressure on the understaffed healthcare sector. This study aims to pilot a new model, the Nurse coordinated Home Care (NCHC) service in suburban Mumbai (India). Methods: In this pilot interventional study, 101 patients with advanced cancer along with their caregivers were enrolled over 16 months. The nurse coordinator (NC) administered study questionnaires every month. Follow-up visits were based on case severity. Local general practitioners (LGPs) were identified and involved in patient care. Results: Severe Edmonton Symptom Assessment System (ESAS) symptoms were reduced by >2 points in 4 out of 7 instances (57.1%). The number of physician visits was lesser than NC visits (162 vs 341), home deaths were more than hospital deaths (57 vs 14), study retention rate was 99%, 87.5% LGPs participated, 98% of questionnaires were returned. Satisfaction on FAMCARE-2 showed a maximum score of ‘Satisfied’, caregiver burden in ZBI was little/no for 95%, mean scores for ESAS pain was 2, PPSv2 score was 70%−100% for the majority, mean scores on EORTC QLQ-C15-PAL were 77 - Functional scales, 21.5 - Symptom scales, and 64.3 - Global health status/quality of life. NCHC median intervention costs per patient were less than usual care (₹2049.50 vs ₹11490.09). Conclusion: A home care service model that includes nurse coordination and case management streamlines access to healthcare services and resources while reducing the cost of care along with reduced caregiver burden, with increased levels of satisfaction.

PATIENT CLAIM FINANCING AT RSUP DR. KARIADI SEMARANG DURING THE COVID-19 PANDEMIC

RSUP Dr. Kariadi Semarang sees both outpatients and inpatients to assess their health status and condition. Patient's health status and condition are classified into two groups: comorbid and co-incident. Patient claims are funded based on status and health conditions of comorbid and co-incident patients. The objectives this research is to know about the patient claim financing procedures of RSUP Dr. Kariadi Semarang during covid-19 pandemic. This research is descriptive qualitative using phenomenological. Primary data sources quotations were chosen using either purposeful sampling or criterion-based selection. The research informants are the primary informants. Informants are Hospital's first primary informant, the Coordinator of Coding Casemixes, and the second primary informant, the Nurse Coordinator of the Covid-19 Handling Room, as well as the first triangulation informant, the Head of the Medical Record Unit, and the second triangulation informant, the Head of the Covid-19 Handling Task Force. Interviews is methods for gathering data. Source triangulation is used for data triangulation. Data analysis using flow model of analysis and interactive analysis model. The result of this research are covid-19 with comorbidity or covid-19 with co-incident in patients because the guarantor is different, the case will be entered twice if it is a co-incident. If the condition is comorbid, the claim is handled separately. Previously, a claim was made for the covid-19 case, and if the covid-19 case was completed but the comorbidities persisted, the guarantor was changed from the Ministry of Health to BPJS Health. The conclusion is during the covid-19 pandemic, the procedures of RSUP Dr. Kariadi Semarang's patient claim financing process are two, such as the guarantor from the Ministry of Health and BPJS Health. Keywords: Patient claim, financing, process

Relationship of Competency of Community Health Nurse Coordinator (Perkesmas) and Level of Implementation of Perkesmas Activities at Public Health Center Work Area of Indramayu District Health Office

Community Health Nursing Service (Perkesmas) is one of the efforts of the puskesmas that supports the improvement of public health status by combining nursing knowledge/practice with public health through the support of active community participation. Perkesmas service activities can be carried out inside and outside the Puskesmas building. Inside the building, nurses provide nursing care for individuals who come to the puskesmas; in contrast, outside the building, nurses can give family nursing care and nursing care for special/health-prone groups in the Perkesmas target area. The purpose of this study was to determine the relationship between the competence of the Community Health Coordinator at the Public Health Center and the implementation of Community Health Activities in the work area of the Indramayu District Health Office. This research used a quantitative and analytical correlation approach with a cross-sectional design. The analysis was carried out in Public Health Centers throughout Indramayu Regency. The sample is 49 nurses appointed as health care coordinators at the Puskesmas. Data was collected through questionnaires, observation, and field supervision. The analysis results showed no relationship between the competence of puskesmas nurses and the level of implementation of health care activities. However, from the effects of partial hypothesis testing, it is known that there is a relationship between knowledge and training with the level of implementation of community health activities.This study recommends increasing the competence of nurses through increasing knowledge and training in hato optimize the implementation of the health care program.

The Role of Procurement Biopsies in Kidney Acceptance Decision Making and Kidney Discard: Perceptions of Physicians, Nurse Coordinators, and OPO Staff and Directors.

Background.Procurement biopsies suffer from challenges with quality and reproducibility and are linked to kidney discard. Nonetheless, procurement biopsies are obtained for the majority of kidneys in the United States, and biopsy findings are commonly relied upon in kidney acceptance decisions.Methods.We conducted in-depth, semistructured interviews with 30 surgeons, nephrologists, nurse coordinators, and organ procurement organization (OPO) staff and directors to assess perceptions of factors contributing to kidney discard and strategies to reduce kidney discard, with a focus on the role of procurement biopsies. Thematic analysis was used to analyze qualitative data.Results.Three main themes emerged: (1) participants emphasized the importance of biopsy findings in making acceptance decisions but expressed concerns about a lack of standardization and quality control; (2) participants reported large variations in the level of importance placed on biopsy findings, the level of reliance on glomerulosclerosis in particular, and the cutoffs used; and (3) participants disagreed about how often procurement biopsies should be taken, with some supporting stricter limits on which kidneys are biopsied and others preferring a biopsy for most kidney offers.Conclusions.These findings support the development of standard practices for which kidneys require biopsy, how the biopsy material is prepared, and how the biopsy is interpreted. Variability in kidney acceptance practices across centers and the use of biopsy findings in guiding recipient selection also lend support to policies to allocate kidneys with suboptimal histological findings to the centers that are willing to use such kidneys and the patients who could most benefit from such offers.

123 - Management of Immune Effector Cell Therapy Care with the Clinical Nurse Coordinator Role

123 - Management of Immune Effector Cell Therapy Care with the Clinical Nurse Coordinator Role