Counteractions to the paradigm shift

While the benefit of a health-focused paradigm is clear theoretically, the transition is tortuous. This article reviews the difficulties of implementing the paradigm shift presented in the preceding article. This article presents counteractions, clarifies underlying assumptions, presents the need for collaborative action, and highlights the potential contribution of case management to the paradigm shift.     

A paradigm shift from competence to Capability in neonatal nursing

A literature review by Bromley (2014) focussing on competence in nursing identified ambiguity and inconsistencies in the assessment or evaluation competence on nurses’ clinical practice (Bromley, 2014; Watson et al., 2002). Flinkman et al. (2017, p. 1036) agree that “there continues to be no consensus on the definition of competence” and that it is a “highly abstract phenomenon … complicated to assess and measure”.A continued review of the literature has identified the theories of capability in higher education and capable graduates. This follow up review will explore the origins of competence and clinical competence as it relates to the nursing profession and compare this with Capability as a means of developing Capable Neonatal Intensive Care (NIC) nursing graduates.     

Hand washing. A paradigm shift

Washing one's hands is one of the principal methods to control infections. At present time, various studies provide evidence that decontaminating one's hands with an alcohol based solution is just as effective, quicker to use and easier. This fact is an important paradigm change in the control over the transmission of infections. The objective of this article is to present and discuss the most relevant aspects of these new recommendations.     

From care plan to concept map: A paradigm shift

Nurses and nursing student must develop and write nursing care plan to provide and organize nursing interventions. Nursing care plans serve as a means of communicating patient care needs between members of the interdisciplinary care team. Traditional linear care plans did not met the educational and functional needs of current nursing students. In an effort to improve nursing students’ clinical reasoning and recognition of interrelatedness of patient data, the traditional care plan format was changed to concept mapping. This article describes the integration of concept mapping in an Associate Degree Nursing program.     

肝功能损害的诊断思路

肝脏的功能很多,而其中最重要的是代谢功能。各种营养物质的合成、分解和转化多在肝脏内进行,体内的代谢产物也要经肝脏转化和解毒,外来物质尤其是药物等化学物质绝大多数需要     

Special considerations in interpreting liver function tests

A number of pitfalls can be encountered in the interpretation of common blood liver function tests. These tests can be normal in patients with chronic hepatitis or cirrhosis. The normal range for aminotransferase levels is slightly higher in males, nonwhites and obese persons. Severe alcoholic hepatitis is sometimes confused with cholecystitis or cholangitis. Conversely, patients who present soon after passing common bile duct stones can be misdiagnosed with acute hepatitis because aminotransferase levels often rise immediately, but alkaline phosphatase and gamma-glutamyltransferase levels do not become elevated for several days. Asymptomatic patients with isolated, mild elevation of either the unconjugated bilirubin or the gamma-glutamyltransferase value usually do not have liver disease and generally do not require extensive evaluation. Overall hepatic function can be assessed by applying the values for albumin, bilirubin and prothrombin time in the modified Child-Turcotte grading system.     

A medical review approach to Medicare outpatient documentation

Blue Cross of California has recognized the problem of reimbursement delays due to Medicare claims that have been returned or denied. The information in this article applies to the medical review process and suggests an interpretation of the new Medicare outpatient guidelines used by the Blue Cross of California Medicare reviewers. As a solution to the problem of delayed reimbursement, medical reviewers--who are also practicing occupational therapists--offer an explanation of the Medicare review process and suggestions for correcting technical billing errors. Methods for keeping complete and timely medical records are discussed, with the suggestion that clinicians follow these methods from the start of care. A process for documentation is presented that will clearly prove to the medical reviewer the need for the special skills of an occupational therapist. This article also proposes reasons for noncoverage because of insufficient medical necessity. It is important to note, however, that variance between fiscal intermediaries' interpretations and requirements exists nationwide. This article, therefore, represents only one fiscal intermediary's approach to reviewing claims and medical records.     

A paradigm shift in the nature of care provision in emergency departments

Objectives: Access block to acute hospital inpatient beds has pressured emergency departments (EDs) to develop strategies to facilitate the management of patients in the community (new services) and to streamline ED care (facilitative initiatives). The aim of this study was to determine the nature and extent of those strategies introduced into the 17 public hospital EDs in Melbourne, Australia, since 1998.

Methods: This was a cross sectional survey of ED directors and/or nurse unit managers undertaken in November and December, 2002. Face to face or telephone interviews were conducted using a researcher administered questionnaire.

Results: All 17 EDs participated. A total of 15 strategies had been introduced into 15 (88.2%) EDs. New services included care coordination teams (12 ED, 70.6%), short stay units (10, 58.8%), psychiatric services (10, 58.8%), chest pain units (7, 41.2%), pharmacy services (3, 17.7%), sexual assault service (1, 5.9%), and hospital in the home within the ED (1, 5.9%). Facilitative initiatives included nurse initiated management (12, 70.6%), fast track processes (10, 58.8%), multidisciplinary triage (4, 23.5%), disposition nurses/communication clerks (3, 17.7%), and day treatment clinics (2, 11.8%).

Conclusions: Melbourne's EDs have adapted rapidly to external pressures of access block and increasing patient numbers. Many traditional inpatient services have now been incorporated into the EDs. These EDs now provide a different and expanded paradigm of care.

     

Clearance tests of liver function.

Measurement of the clearance of substances removed from the circulation primarily by the liver, which depends on the uptake, storage, and excretory capacity of the liver, provides the most sensitive, specific, and reliable test for hepatic function. Since serum enzymes and other tests of liver function do not permit detection of early phase injury or provide information on progress, and since the use of sulfobromophthalein has been discontinued because of occasional fatal reactions, substitutes are necessary. Clearance of indocyanine green, bile acid, and exogenous metabolites such as galactose, protein, and aminopyrine are reviewed.     

A paradigm shift in nursing education: a new model

Nurse educators are being inspired to rethink historically teacher-centered curriculum designs and to embrace new ideologies that have a stronger focus on student-centered learning. The paradigm shift is reflected in the National League for Nursing's call for nursing education to respond to the changing needs of our student population by providing an educational learning environment substantiated in evidence for both curriculum and pedagogical practice. To meet these expectations, education should provide active learning that promotes critical thinking and analysis and problem-solving skills. This article presents a model for higher education in nursing that takes into account the learner, the instructor, and the systems that influence their relationships, providing congruence for educational outcomes.     

Predictive values of various liver function tests with respect to the diagnosis of liver disease

A prospective study of 181 patients suspected of having liver disease was carried out to determine the relative efficiencies of serum bilirubin (total and direct), alkaline phosphatase (AP), gamma glutamyl transferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) with respect to diagnosis. Liver biopsies, liver scans, abdominal ultrasound, and clinical parameters were also tabulated and used independently to evaluate the patient's hepatic status and to determine the final diagnoses in each case. From the results of these tests for the 60 patients who were diagnosed as having liver disease, and the 87 patients who were felt to be free of liver disease, predictive values of the above tests were established. Data from this study suggests that while direct bilirubin is the most specific test, GGT is the most sensitive and has the fewest false negatives in the diagnosis of liver disease.     

Health promotion in heart failure--a paradigm shift

For people living with heart failure, levels of health exist along a continuum in correlation with the illness experience. A focus on health promotion rather than only disease or symptom management expands opportunities for self-care and presents an emerging paradigm shift in the care of people with heart failure. Results from 2 studies revealed that few health-promoting behaviors were reported by patients with heart failure until a focused intervention that emphasized health promotion as part of self-care was implemented.