The perfect storm: managed care, aging adults, and a nursing shortage

The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from the insurer to the provider. Yet, of 257 data-based studies of nursing care quality identified, 135 investigated a process-outcome link but only 17 met study inclusion criteria. The literature provides evidence that the quality of nursing care processes affects health-related patient outcomes during and after hospitalization. Thus, California became the first state to mandate nurse staffing ratios on all units in 1997. All the while labor shortages, introduction of new technology, and the increased acuity of the inpatient population have contributed to the rising costs of hospital-based care. Another notable contribution to the financial and clinical pressures hospitals feel is the overall increased consumer demand for services: The aging of America's population portends an even greater demand for healthcare services. This situation will only grow worse as the demand generated by the growing gerontocracy increasingly outstrips an affordable supply of safe care. Little time and few resources are available for what we might all agree would be the desired level of comprehensive and coordinated care. What this means for patients is that they experience episodic acute care that is delivered in "spurts." No matter what actions are taken - or more likely not taken - to reform the Medicare program, the future holds shrinking reimbursement for hospitals, with a concurrent demand for investments in response to costly regulatory requirements, technologies, and other capital expenditures to accommodate the increasing demand for services generated by the growing numbers of politically active seniors who insist on the entitlements promised to them - and the quality of service they believe is their right. This is the Perfect Storm....     

Confronting the perfect storm: a challenge to nurse leaders

As leaders confront the issues and impending problems of today and the future, their number and complexity may overwhelm some. The individuals and organizations who will energize themselves and others to meet the challenges of healthcare are those who maintain quality patient care as their central priority, have a bias for action, and collaborate with other stakeholders. In this article, the immediate past president of the American Organization of Nurse Executives describes how some organizations are doing just that.     

Weathering the storm: challenges to nurses providing care to nursing home residents during hurricanes

This article documents the experience of 291 Florida nursing homes during the 2004 hurricane season. Using quantitative and qualitative methods, the authors described and compared the challenges nurses encountered when evacuating residents with their experiences assisting residents of facilities that sheltered in place. The primary concerns for evacuating facilities were accessing appropriate evacuation sites for residents and having ambulance transportation contracts honored. The main issue for facilities that sheltered in place was the length of time it took for power to be restored. Barriers to maintaining resident health during disasters for those who evacuated or sheltered in place are identified.     

The pharmaceutical industry and mental health nursing

Mental health nurses (MHNs) have a long and varied relationship with the pharmaceutical industry, including the attendance of educational seminars and the acceptance of promotional material. This article presents evidence that suggests MHNs may need to review this relationship regardless of their beliefs about the role of pharmacological interventions in the treatment of mental illness. It also explores the influence of advertising within professional journals and calls for greater debate on this issue.     

Corporate attitudes and responses to rising health care costs

Faced with eroding profitability from rising health care costs, corporations are beginning to aggressively implement cost containment strategies. Although few companies have coordinated long range plans in place, corporations' attempts to exert control over the health care system will affect insurers, providers, and consumers. Occupational health nurses need to be aware of how cost-containment pressures will affect the various aspects of the U.S. health care system if they want to influence the changes. Occupational health nurses have an opportunity to work with benefits personnel and others in their company to maximize employee health while helping to implement programs to contain health care costs.     

13例心室电风暴患儿的急救护理

总结13例心室电风暴患儿的急救护理经验。护士及时备好急救的仪器和药物,立即建立静脉通道,积极配合做好食管心房调搏术、体外电击复律除颤术,射频消融术的护理,并做好家属的心理疏导,同时密切观察药物疗效及病情变化。工作中操作熟练、有条不紊是保证患儿顺利康复的关键。本组死亡1例,其余均救治成功。     

Employee health surveillance in the health care industry.

This article provides an overview of the fundamental and inherent challenges in developing a health surveillance program for a health care facility. These challenges are similar to those facing individuals responsible for developing health surveillance programs for multiple industries because several "mini-industries" exist within hospitals. Hazards can range from those that are regulated by the Occupational Safety and Health Administration to those that are unregulated but pose a threat to health care workers. Occupational hazards that are unique to the health care industry also exist. A health surveillance program can be developed with focused assessment and a strong occupational safety and health program. Implementation can occur within a health care setting with the buy-in of the many stakeholders involved, especially supervisors managing departments where chemical and other hazards are present.