Shift In Health Care Delivery Research Articles

Wait-time benchmarks fall short

New wait-time benchmarks announced Dec. 12 by the federal government were both lauded as a major shift in health care delivery and criticized for failing to set deadlines for implementation. The announcement fulfils a promise made in the September 2004 federal/ provincial health accord to establish

Family Caregivers?? Medication Management of Symptoms in Patients With Cancer Near Death

The purpose of this study was to understand the process of medication management of symptoms in patients with terminal cancer near death in the home from the perspective of family caregivers. The shift of healthcare delivery from the hospital to the home and the availability of palliative care/hospice expertise have increased the number of patients with terminal disease staying at home until death. The literature reveals that symptoms of distress such as pain, dyspnea, agitation, or nausea often occur in these patients, and control of symptoms with medications is required to provide comfort until death. Family caregivers become the medication managers who are challenged with this task in the home. Grounded theory methodology was used to identify the process of managing medications for symptoms in patients with cancer near death from the perspective of family caregivers. Data for the study consisted primarily of semistructured interviews with 17 female caregivers of patients with terminal cancer receiving home hospice care. Interviews were transcribed and analyzed using the constant comparative method of simultaneous data collection and analysis. The theory of Family Caregivers' Medication Management of Symptoms in Patients with Cancer near Death emerged with six stages: committing to be caregiver; taking on role of medication manager; achieving balance; recognizing changes near death; allowing adjustment of the balance; and evaluating self-efficacy and use of medications after the death. The core variable in the process was identified as “committing to the person to the end.” Nurses in practice should recognize that caregivers rely on the clinical judgment of home hospice nurses to develop medication schedules to facilitate control of symptoms and to arrange for emergency medications in the home. Healthcare policy needs to ensure access to hospice services for all Americans. Future research on caregiver self-efficacy in the period of bereavement and beyond is recommended.

Food Safety and Foodborne Disease in the 21st Century

Over the past decade there has been a growing recognition of the involvement of the home in several public health and hygiene issues. Perhaps the best understood of these issues is the role of the home in the transmission and acquisition of foodborne disease. The incidence of foodborne disease is increasing globally. Although foodborne disease data collection systems often miss the mass of home-based outbreaks of sporadic infection, it is now accepted that many cases of foodborne illness occur as a result of improper food handling and preparation by consumers in their own kitchens. Some of the most compelling evidence has come from the international data on Salmonella species and Campylobacter species infections.By its very nature, the home is a multifunctional setting and this directly impacts upon the need for better food safety in the home. In particular, the growing population of elderly and other immnocompromised individuals living at home who are likely to be more vulnerable to the impact of foodborne disease is an important aspect to consider. In addition, some developed nations are currently undergoing a dramatic shift in healthcare delivery, resulting in millions of patients nursed at home. Other aspects of the home that are unique in terms of food safety are the use of the home as a daycare centre for preschool age children, the presence of domestic animals in the home and the use of the domestic kitchen for small-scale commercial catering operations. At the global level, domestic food safety issues for the 21st century include the continued globalization of the food supply, the impact of international travel and tourism, and the impact of foodborne disease on developing nations.A number of countries have launched national campaigns to reduce the burden of foodborne disease, including alerting consumers to the need to practice food safety at home. Home hygiene practice and consumer hygiene products are being refined and targeted to areas of risk, including preventing the onward transmission of foodborne illness via the inanimate environment. It has been said that food safety in the home is the last line of defense against foodborne disease, and it is likely that this will remain true for the global population in the foreseeable future.

Management of Postmenopausal Osteoporosis for Primary Care

The shift in health care delivery from a subspecialty to primary care system has transferred the responsibility of preventing osteoporotic fractures from specialists in metabolic bone disease to the web of physicians--family practitioners, general internists, pediatricians, and gynecologists--who provide the bulk of primary care. The challenge for this group of physicians is to decrease the rising prevalence of osteoporotic hip and vertebral fractures while operating within the cost parameters. It is the goal of this brief summary to provide primary practitioners with focused guidelines for the management of postmenopausal osteoporosis based on new and exciting developments. Prevention and treatment will change rapidly over the next decade and these advances will require changes in these recommendations. We identified patients at risk for osteoporosis and provided indications for bone mass measurement, criteria for diagnosis of osteoporosis, therapeutic interventions, and biochemical markers of the disease. Prevention and treatment are discussed, including hormone replacement therapy and use of calcitonin, sodium fluoride, bisphosphonates, and serum estrogen receptor modulators. Postmenopausal osteoporosis should no longer be an accepted process of aging. It is both preventable and treatable. Primary care physicians must proactively prevent and treat osteoporosis in their daily practice, and combination therapies are suggested.

Nurse practitioner descriptions for primary care centers: opportunities for ownership.

The drastic shift in health care delivery and the accompanying emphasis on health care outcomes has contributed to a rapid proliferation of nurse practitioner services. Prepared as advanced practice nurses with specific assessment skills, primary care nurse practitioners have the opportunity to be participant players rather than observers in business negotiations. To gain a market share of the expanding field, these nurses must assert their position on establishing primary care centers. This qualitative study focused on nurse practitioner descriptions of their needs in a university primary care group practice. Four major response patterns, Vision, Structure, Incentives, and Significance, were clarified by multiple themes defined by explanatory elements for a research-based topology to guide nurse practitioners and schools into positions of ownership of primary care centers in interdisciplinary partnerships.

Nursing Assessment of Families with Young Children: Developmental Screening Tools for Home Use

Five assessment tools appropriate for families with young children are discussed. The tools chosen are valid and reliable and adaptable to use within the home setting. The tools identified are: The Brazelton Neonatal Assessment Scale, The Denver II, The HOME Scale, The Family APGAR, and The McMaster Family Assessment Device. With the shift in health care delivery into the community, nurses need to be prepared to complete assessments efficiently and effectively. The tools presented are widely used. None is diagnostic but each serves as a basis for further evaluation when combined with other available data. Each is best used when combined with a comprehensive, primary health care approach that is fundamental to health promotion and early intervention.

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