APN Knowledge,Self‐Efficacy,and Practices in Providing Women's Healthcare Services to Women with Disabilities

Women with disabilities require the same gynecological and reproductive healthcare services as women without disabilities, yet they often experience difficulty obtaining them. Advanced practice nurses (APNs) increasingly provide primary care services that include women's health care, yet their influence on this population has not been systematically examined. This study examined the practices, environments, knowledge, and self‐efficacy of APNs in Texas regarding provision of women's health care to women with disabilities. The study's respondents are 744 women who replied to a mailed survey. The results reveal that while nurses do not lack knowledge, work environments do not support competent care of women with disabilities and practices do not always follow national guidelines. Predictors of self‐efficacy in provision of health care to women with disabilities were status as a women's health nurse practitioner, previous rehabilitation experience, high knowledge scores, and a working environment perceived as accessible. Until changes are made in APN education and environmental barriers are addressed, APNs may not be able to provide optimal women's healthcare services to women with disabilities.     

Complex Responsive Processes: A New Lens for Leadership in Twenty‐First‐Century Health Care

PROBLEM. Health care is currently in the midst of an age change. Leadership styles and organizational structures that were prevalent in the twentieth century no longer apply in twenty‐first‐century health care. Leaders of health care must embrace and help others to embrace new ways of being and relating in twenty‐first‐century organizations. METHODS. This paper introduces a new framework through which leaders can see their organizations differently. Complex responsive processes (CRPs) focus on the interactions between people that take place in the living present as the building block of transformative organizations. This paper also introduces the seven da Vincian principles as a personal tool that twenty‐first‐century leaders might use to increase their capacity for creativity and to develop their ability to thrive in uncertainty. FINDINGS. The power to shape the preferred future of health care lies within our relationships with others that take place locally and in the living present. CONCLUSIONS. Viewing organizations through the lens of CRPs and developing practices around the seven da Vincian principles provides directions and a starting point for traditional leaders to move away from rationalist, twentieth‐century practices toward transformative leadership practices.     

Does systematically organized care improve outcomes for women with diabetes?

Objective To investigate whether financial reimbursement for a bundle of diabetes care items self‐reported by general practitioners (GPs) leads to improved outcomes for women with diabetes. Methods Longitudinal cohort study of women in the Australian Longitudinal Study on Women's Health aged 45–50 and 70–75 years when recruited in 1996. Outcomes Short Form 36‐item (SF‐36), Medicare and pharmaceutical benefits costs 2002–2005, uptake of annual cycle of care for diabetes (ACC). Results Annual cycle of care claims were identified for 23% of 388 mid‐age, and 40% of 616 older women with diabetes. ACC was not associated with statistically significantly higher costs in either group. Women for whom the GP had received an ACC fee were more likely to have been overweight, had more GP visits, more medications, and more ‘no cost’ visits. Unlike older women, mid‐age women for whom the GP had received an ACC fee were more likely to have difficulty managing on their income and tended to have worse physical and social function scores prior to the time the ACC was introduced and compared with other women with diabetes continued to have poorer scores at subsequent surveys. There was no association between ACC, co‐morbidities or country of birth. Women who developed diabetes after the first survey (incident cases) tended to have better SF‐36 health profile scores and lower costs than those who reported diabetes on the first survey (prevalent cases). Conclusions General practitioners of women with diabetes, who have more health care encounters and poorer health‐related quality of life, have adopted ACC with little impact on the decline in quality of life of the women nor on health care costs.