Where Has “Patient Care” Gone?

As we rush around attending to the essentials of our lives (family, friends, clients, employers), what is left?Nursing Forum invites readers to engage in thoughts and activities that may awaken an untouched place. We hope these writings will kindle your personal involvement in something that was previously avoided—because of bias, fear, or uneasiness—in order to stretch your mind and spirit.     

新时期保健模式下提升医院医疗保健质量的做法

随着军队深化改革以及海军部队的发展,保健对象的人群越来越庞大,对保健质量的期望值持续上升。新时期下,建立健全保健工作体系,优化保健队伍结构;更新管理理念,完善保健制度;加强思想教育,增强责任意识;提高院外急诊能力,突出"一专多能";实行信息化管理等,提高了保健人员综合能力、健康意识、疾病的早诊断率。     

Can Money and Morality Mix in Medicine?

ABSTRACT
The escalation of health care costs in the United States has become a problem now that business and taxpayers are paying larger shares of these costs. Many believe that the only way to cope with rising costs is to institute explicit rationing of access to health care services. Proposals to ration based upon age, "sin" exclusions, physician gatekeeper incentives, patient ability to pay, and community values all have shortcomings. An alternative approach to controlling costs that emphasizes efficiency by cutting administrative and malpractice overhead costs and universally providing those medical services that have proven patient benefit is proposed. Physicians must take a more active role in the debate to ensure that patient needs are met and that expenditures are directed toward effective therapies.     

Desarrollo de la competencia de atención comunitaria para residentes de Enfermería Familiar y Comunitaria en una Unidad Docente Multiprofesional provincial. Tres años de experiencia

ObjectiveTo determine the interest of nursing residents in the training areas of Family and Community Nursing (EFyC) at the beginning of their training, to evaluate community activities in health centres and to determine satisfaction with the training received and activities carried out.MethodWe present the experience of training in the public and community health competencies of EFyC Nursing from 2014 to 2017 in a multiprofessional teaching unit. The training was divided into 3 theoretical modules. The training was completed with 2 activities: the design and development of a health education programme and an asset mapping in the basic health area. A questionnaire was completed on satisfaction with the course and the activities carried out.ResultDuring this period, 27 residents received training.As part of the training process, 26 health education programmes and 17 asset mappings were conducted in accredited health centres. The areas of intervention addressed were: lifestyles, life transitions and health problems.The overall satisfaction with the course was 4.5 ±.1 out of 5.ConclusionsThe results show a high degree of interest in this area, as well as high evaluation of the activities carried out and the training received.Training in community health and health education during the period of residence is essential to include these competencies in the professional role. The dedication and involvement of the multiprofessional teaching units is essential in the development of these competences, training the residents through the integration of a biopsychosocial approach, community health and teamwork in primary care.     

Health, economic evaluation, and critical care

In the past 2 decades, societal spending on health care has become an international concern. The United States currently spends more than 1.6 trillion dollars per year on health care--approximately 15% of the gross domestic product. The provision of care to critically ill patients accounts for a disproportionate share of these health care dollars--approximately 13% of hospital costs, 4% of national health expenditures, and 0.5% to 1% of the gross domestic product. This enormous investment necessitates careful evaluation of our interventions and their associated expense. Economic evaluation can aid policy makers and health care professionals in comparing the relative and incremental value of disparate and expensive therapies and also inform decisions about which interventions provide good value for the health care dollar. In this review, we will highlight landmark publications over the past decades that have helped to shape the field of economic evaluations for critical care medicine.     

社区高血压患者用药的卫生宣教

目的探讨对社区高血压患者用药的卫生宣教及其行为干预在有效控制血压上的价值。方法对合肥市西园新村社区已用药治疗半年以上的100名高血压患者随机分组,实验组和对照组各50名,实验组做为期4周的有关药物治疗的卫生宣教和行为干预,比较干预前后两组患者的问卷调查和血压测量的结果。结果在药物治疗行为和血压控制方面,两组患者差别有显著性意义(P<0.05)。结论对社区高血压患者药物治疗进行具体、长期的指导,可提高服药的依从性,提高对高血压的控制率。     

健康教育对提高糖尿病患者口腔保健知识与行为的影响

目的了解糖尿病（DM）患者对牙周病变防治知识的认识;探讨实施健康教育对提高糖尿病患者口腔保健知识与行为的影响.方法采用调查问卷方法了解100例2型糖尿病患者对牙周病变及其预防知识的认识;在实施教育前、后评估患者口腔保健知识与行为的变化.结果教育前半数以上患者对糖尿病合并牙周病变防治知识的认识不足;近三分之一的糖尿病患者的口腔保健知识与行为不良;糖尿病教育后患者的口腔保健知识与行为发生明显改变（P＜0.05）,85%以上的糖尿病患者掌握了相关的口腔保健知识,并已逐步养成良好的口腔保健行为.结论糖尿病教育对提高患者的口腔保健知识与行为有积极的促进作用,在糖尿病的综合防治中,应重视糖尿病合并牙周病变的早期防治知识教育,强化口腔保健知识与行为,有利于减少糖尿病患者牙周病变的发生.     

Primary health care in Saudi Arabia: applying global aspects of health for all, locally

Primary health care in Saudi Arabia: applying global aspects of health for all, locally This paper describes the application of primary health care principles in the Islamic Kingdom of Saudi Arabia. It arose from a doctoral supervisory experience on a joint programme for women students, operating between a British and Saudi Arabian University. The research looked at nutritional advice given by diploma-level nurses to pregnant women attending primary health care centres in Saudi Arabia. The supervisor supported research that drew on internationally recognized trends in nursing research (the reflexive learner) whilst attending to local requirements and conventions of the culture. The student was encouraged explicitly to site the research within the framework of Islamic teaching and Saudi culture. The Qur'an was used as an overarching framework within which the tenets of primary health care were explored. This was seen to be crucial in addressing World Health Organisation and the International Council of Nurses' views on contextualizing nursing for the greatest benefit of the population. This was of particular relevance in Saudi Arabia where research carried out in the community by women is novel, and as yet there are no nurse theorists from within Saudi culture.     

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: Protocol for a randomised controlled trial

Background

People with a serious mental illness are at significantly greater risk of poor cardiometabolic health with recent studies showing a greater than two-fold increase in the risk of obesity, infectious diseases, diabetes and cardiovascular disease. Contributing factors to this disparity include poorer health behaviours such as suboptimal physical activity, poor diet, smoking, alcohol and illicit drug misuse. In particular, the limited access to primary health care experienced by people with a serious mental illness has been highlighted. Persons with a serious mental illness are around 30% less likely than those without serious mental illness to receive health assessments, hospital admissions or procedures for cardiovascular disease and diabetes, and are less likely to undergo cancer screening or receive vaccinations. Studies show that mental health consumers may be more likely to use mental health services rather than primary care for contact with the health care system. However mental health nurses report several barriers to their capacity to provide cardiometabolic health care crucial for the treatment of people with a serious mental illness.

Objectives

To assess the impact of a specialist Cardiometabolic Health Nurse on the physical health care of community based mental health consumers.

Setting

Community mental health facility in a large regional centre in Central Queensland, Australia.

Design/methods

Community based mental health consumers will be randomised to receive either usual care, or consultations with a Cardiometabolic Health Nurse. The Cardiometabolic Health Nurse will be responsible for assessing the client and coordinating cardiometabolic health care as required. Post intervention review of health records will be performed with the primary outcome measure being self-reported physical health. Secondary outcomes include the utilisation of primary care services and changes in health behaviours. We hypothesise that the Cardiometabolic Health Nurse will increase the utilisation of health care services for mental health consumers.

Results

Data collection commenced in March 2013 and will conclude September 2013. Preliminary finding are expected in December 2013.     

Spiritual formation,secularization, and reform of professional nursing and education in antebellum America

The origin story of professional nursing associated with antebellum American faith communities is all but lost. This paper provides historical evidence for professional nursing for that period using a case study approach that examines three faith communities: the Sisters and Daughters of Charity, the Shakers, and the Church of Jesus Christ of Latter Day Saints. The purpose is to present an historical analysis of the three communities' health beliefs, recipes and remedies that were foundational to the spiritual formation and education of professional nurses within their communities. The focus of the analysis is to place the evidence for professional nursing in these faith communities within the broader context of the contemporary American narrative of the “secularization” of professional nursing associated with the adoption of the Nightingale Training Model after 1873. Nursing became a profession in America because of the courage and passion of many for spiritual formation in community around a need to relieve suffering and demonstrate kindness. The history of American nursing is comprised of stories of powerful nurse ancestors that have the potential to inspire and unite us in that same purpose today despite the ambiguities that may still exist around spirituality, religiosity, and secularization.     

Estimating transition probabilities in mobility and total costs for medicare beneficiaries

Hoffman JM, Ciol MA, Huynh M, Chan L. Estimating transition probabilities in mobility and total costs for Medicare beneficiaries.

Objective

To examine how persons move back and forth along levels of mobility disability.

Design

Self-reported mobility limitations were used to create categories of annual transition states. The total cost to Medicare associated with each year was calculated for each participant. In addition, we examined cost relative to transition state, adjusting for demographic and other health status variables.

Setting

National survey.

Participants

Participants in the longitudinal Medicare Current Beneficiary Survey from 1992 to 2005.

Interventions

Not applicable.

Main Outcome Measures

Annual self-reported mobility limitations and total Medi costs.

Results

Most participants remained without mobility limitations or improved over time. Reported average costs were 10 times higher for those who transitioned to severe limitations, unable to walk, or death compared with persons who reported no mobility limitation. Estimated costs were highest for those transitioning to increased states of disability and to death.

Conclusions

Mobility limitations in older adults are dynamic, and improvement (as measured by annual transitions) occurred for a large number of Medicare beneficiaries. High total annual costs were observed in groups that transitioned to worsening mobility states, suggesting a link between mobility limitation transitions and cost. Prevention and treatment of mobility limitation may be an important factor to consider in health care reform.     

Commentary: Public health approaches to palliative care – The progress so far

This article provides an academic and professional context for the articles written for this special issue. It discusses 4 broad questions often asked about the public health approach to palliative care: what is the evidence for the effectiveness of the approach?; will this approach embedded inside palliative care services deliver the kinds of social changes needed to address the social epidemiology of living with life-limiting illness, long term caregiving and grief and bereavement?; Is recent interest in this approach simply all about cost-savings for governments?; and will an emphasis on health promotion and community development subtract from efforts to increase or maintain clinical supports at the end of life?     

Quality indicators for the care of older adults with disabilities in long-term care facilities based on Maslow’s hierarchy of needs

PurposeThis study aimed to develop quality indicators for the care of older adults with disabilities in long-term care facilities (LTCFs) based on Maslow’s hierarchy of needs.MethodsThe draft of the quality indicators was drawn up based on a literature review and research group discussion. The quality indicators were finalized by two rounds of expert consultation (involving 15 experts) using the Delphi method. The Analytic Hierarchy Process was applied to calculate the indicators’ weight.ResultsThe response rates of the two rounds of consultation were 100% and 93%, and the expert authority coefficients were 0.86 and 0.87. After two rounds of consultation, the expert opinion coordination coefficients of the first-, second- and third-level indicators were 0.42, 0.25, and 0.96, respectively (P < 0.05), and the variation coefficient was ≤0.25. The final quality indicators for the care of older adults with disabilities in LTCFs included 7 first-level, 19 second-level, and 107 third-level indicators.ConclusionThe quality indicators for the care of older adults with disabilities in LTCFs are reliable, scientific, comprehensive, and practical and specify the content of person-centered care needs. This can provide a reference for evaluating and improving care quality in LTCFs.     

本专科护生特质应对方式、社会支持与心理健康相关分析

目的:了解本专科护生心理健康状况,分析特质应对方式与心理健康的关系。方法:应用特质应对方式问卷、社会支持评定量表、青少年生活事件量表、SCL-90症状自评量表及一般情况调查表对2 253名本专科护生进行调查分析。结果:本科护生心理健康状况较专科护生差。积极应对方式和消极应对方式与SCL-90各因子、青少年生活事件各因子间分别存在负相关和正相关(P<0.01),而其与主观支持、客观支持和支持利用度之间分别存在正相关和负相关(P<0.01)。结论:心理健康状况及生活事件与本专科护生的特质应对方式、社会支持存在相关性。