Shift In Health Care Delivery Research Articles

LPN-BSN: education for a reformed health care system.

Nursing practice has experienced a paradigm shift in health care delivery from hospitals to community-based models of health care. Nursing education must respond to accommodate the shift through curriculum reform. This article discusses a LPN-BSN program to promote educational mobility for LPNs while educating them for a reformed health care system. The needs assessment and curriculum implementation are discussed. Student comments and experiences are included throughout. Student academic support and recruiting which addresses the special needs of the LPN-BSN student are also described. The evaluation of the project thus far indicates student success.

Ambulatory infusion pumps: Application to oncology

To provide an overview of the various types of ambulatory pumps available in relation to mechanism of delivery, patient selection criteria, potential complications, and educational support. Ambulatory pumps are an important means of drug delivery in a wide range of clinical conditions. Technologies permitting drug self-administration and automated drug delivery outside the hospital have become increasingly more sophisticated and adaptable; more than 600 models are available. With the shift of health care delivery from the hospital setting to the outpatient and home settings, reliable effective ambulatory pumps are necessary to safely deliver medications. The use of ambulatory pumps is becoming more common as they are initiated as a part of front-line patient therapy. The nurse involved in the selection and management of ambulatory pumps is challenged to be familiar with the large variety available. Selecting the best type of pump is based on several factors, such as the type of therapy, disease state, reimbursement, and the ability to operate and troubleshoot complications.

An introduction to practical healthcare epidemiology.

The Society for Healthcare Epidemiology of America (SHEA) is completing preparation of A Practical Handbook for Hospital Epidemiology. The Handbook is intended to be a pragmatic guide that will assist both neophyte and experienced epidemiologists in establishing and operating a successful hospital (or other healthcare) epidemiology program. The Handbook will be published in book form later in 1995. In the meantime, we will inaugurate a new section of the journal entitled "Practical Healthcare Epidemiology," which will begin by presenting one chapter from the Handbook each month. This issue of Infection Control and Hospital Epidemiology features the first of more than 30 installments, Bryan Simmons' and Stephen Kritchevsky's chapter "Epidemiologic Approaches to Quality Assessment." Next month, in a chapter entitled 'The Hospital Epidemiologist: Practical Ideas," Richard Wenzel will present his overall philosophy of, and approach to, hospital epidemiology. I feel that this is an especially propitious time to launch this new venture because, as stated by Faith Popcorn, futurologist and advisor to Fortune 500 corporations, 'These are bizarre times."1 If the times are bizarre for Fortune 500 companies, they are even more bizarre for healthcare providers who must respond to the demands of a myriad of discontented customers—patients, corporations, third-party payers, and the federal government, to name only a few. As we all can attest, the golden era of unlimited budgets for healthcare is over. The economic and social forces that drive other businesses no longer will spare hospitals. Because they must reduce costs drastically while increasing quality and accessibility, hospitals are being forced to shift the center of healthcare delivery from the inpatient to the outpatient setting and to shift the focus of healthcare economics from generating revenue through fee for service to amassing capitated lives. These cataclysmic shifts in healthcare delivery and economics will affect profoundly those practicing infection control. As hospital epidemiologists and infection control practitioners, we either can resist these forces or we can anticipate trends and implement change. If we choose the former, we will be supplanted by those who respond quickly to the pressures but whose vision for health protection is blinkered. In contrast, if we choose the latter, we will help our hospitals survive, and we will assure new and expanded roles for those trained in infection control. We would do well to heed Tom Peters's warning that businesses and individuals will survive in our evermore-competitive economy only if they embrace and thrive on change.2 Clearly, the future of hospital epidemiology and infection control depends not only on our epidemiologic skills but also on how well we apply those skills within the changing environment. This changing environment discomfits and challenges even experts in hospital epidemiology and infection control; it can be daunting for those who are just entering the field. Although several excellent textbooks of infection control and quality assessment3-6 are available as scientific references for hospital epidemiologists and infection control practitioners, these textbooks have

An Introduction to Practical Healthcare Epidemiology

The Society for Healthcare Epidemiology of America (SHEA) is completing preparation of A Handbook for Hospital Epidemiology. The Handbook is intended to be a pragmatic guide that will assist both neophyte and experienced epidemiologists in establishing and operating a successful hospital (or other healthcare) epidemiology program. The Handbook will be published in book form later in 1995. In the meantime, we will inaugurate a new section of the journal entitled Practical Healthcare Epidemiology, which will begin by presenting one chapter from the Handbook each month. This issue of Infection Control and Hospital Epidemiology features the first of more than 30 installments, Bryan Simmons' and Stephen Kritchevsky's chapter Epidemiologic Approaches to Quality Assessment. Next month, in a chapter entitled 'The Hospital Epidemiologist: Ideas, Richard Wenzel will present his overall philosophy of, and approach to, hospital epidemiology. I feel that this is an especially propitious time to launch this new venture because, as stated by Faith Popcorn, futurologist and advisor to Fortune 500 corporations, 'These are bizarre times.1 If the times are bizarre for Fortune 500 companies, they are even more bizarre for healthcare providers who must respond to the demands of a myriad of discontented customers—patients, corporations, third-party payers, and the federal government, to name only a few. As we all can attest, the golden era of unlimited budgets for healthcare is over. The economic and social forces that drive other businesses no longer will spare hospitals. Because they must reduce costs drastically while increasing quality and accessibility, hospitals are being forced to shift the center of healthcare delivery from the inpatient to the outpatient setting and to shift the focus of healthcare economics from generating revenue through fee for service to amassing capitated lives. These cataclysmic shifts in healthcare delivery and economics will affect profoundly those practicing infection control. As hospital epidemiologists and infection control practitioners, we either can resist these forces or we can anticipate trends and implement change. If we choose the former, we will be supplanted by those who respond quickly to the pressures but whose vision for health protection is blinkered. In contrast, if we choose the latter, we will help our hospitals survive, and we will assure new and expanded roles for those trained in infection control. We would do well to heed Tom Peters's warning that businesses and individuals will survive in our evermore-competitive economy only if they embrace and thrive on change.2 Clearly, the future of hospital epidemiology and infection control depends not only on our epidemiologic skills but also on how well we apply those skills within the changing environment. This changing environment discomfits and challenges even experts in hospital epidemiology and infection control; it can be daunting for those who are just entering the field. Although several excellent textbooks of infection control and quality assessment3-6 are available as scientific references for hospital epidemiologists and infection control practitioners, these textbooks have