Establishing prices: one hospital's strategic response

Establishing appropriate prices for health care products has been an ongoing problem. Price increases have traditionally been based on an across-the-board percentage increase for all products. In this article, the importance of pricing and the actual pricing methodology used at Baptist Medical Center in Kansas City, Missouri are discussed.     

Examining HIV-positive parents' disclosure to their children: a biopsychosocial approach

In the post HAART era, the biopsychosocial issues now facing HIV-positive parents concerning disclosure of their status to their children need to be understood in the context of chronic disease. This article describes the experiences of 101 adult HIV-positive urban in-treatment mothers and fathers of school-age children on disclosure, psychological distress, social support, and symptom severity. Key variables associated with parents' HIV disclosure were the age of parent and of children in the household, parents' HIV-related symptoms, and parent ethnicity. Cultural and maturational, rather than psychological or social factors were significantly related to parents' HIV disclosure.     

Nurse retention: an executive's guide to keeping one of your hospital's most valuable resources

Our executive guide outlines the five characteristics of a successful retention program, illustrates the nine principles of a helpful work environment and provides case studies of hospitals that found effective ways to encourage nurses to remain on the job.     

Female disclosure of HIV-positive serostatus to sex partners: a two-city study

The aims of this article are (1) to describe the prevalence of disclosure of HIV serostatus to sex partners among a racially/ethnically diverse sample of HIV-positive women living in Hawai'i and Seattle, Washington; and (2) to examine factors related to disclosure and condom use with those sex partners. HIV-positive women have difficulties consistently disclosing serostatus to sex partners and using condoms. Little is known about the disclosure practices of women from Hawai'i or Seattle. A cross-sectional design with convenience and snowball sampling was used, and up to three recent sex partner experiences were assessed among the HIV-positive participants (N = 84). A total of 133 recent sex partners were reported, with disclosure and condom use frequencies of 75.2 and 59.9%, respectively. Women who knew when it was safe to disclose were more likely to disclose. Women who disclosed to recent sex partners were less likely to use condoms, while those in casual/anonymous partnerships were more likely to use condoms. Hawaiian/part Hawaiian women had the lowest proportion of condom use. Health care personnel should routinely discuss disclosure and sexual transmission risk behaviors with seropositive women and offer strategies to enhance condom use, especially among those in committed partnerships. Culturally tailored interventions focused on strengthening efficacy beliefs for disclosure and condom use in Native Hawaiians are needed.     

Project MotherCare: one hospital's response to the high perinatal death rate in New Haven,CT.

Starling national statistics indicate that New Haven, CT, is the seventh poorest city of its size, in terms of per capita income, in the United States. In 1989, it was reported to have the highest rate of infant mortality--18.5 infant deaths per 1,000 live birth--in the nation for a city with more than 100,000 people. Seventy-five percent of all perinatal deaths are attributed to low birth weight infants. Adequate prenatal care is a proven means of reducing this risk. To further compound the problem, substance abuse among pregnant women has increased dramatically. Census tract data revealed that many of the infant deaths were localized to several well-defined areas of the city. Forty-four percent of the infant deaths were ascribed to extreme immaturity or other causes related to low birth weight. Approximately 21 percent of the pregnant population had either no prenatal care or care was begun late--after the first trimester. The traditional avenues for prenatal care have been ineffective; an innovative approach, one that can be replicated, was initiated. The Hospital of Saint Raphael''s "Project MotherCare" embarked on an initiative to address these problems by reducing the access barriers to prenatal care regardless of insurance status or ability to pay. The mission was twofold: (a) to bring prenatal care to underserved neighborhoods of New Haven and (b) to identify the substance-abusing pregnant woman and deliver a continuum of services including prenatal care, counseling, social services, and referral to a drug treatment program.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Law of Communicable Diseases Act and disclosure to sexual partners among HIV-positive youth

In Sweden, human immunodeficiency virus (HIV) is included among the venereal diseases covered by the Law of Communicable Diseases Act. HIV-positive (HIV(+)) people are required to inform their sexual partners about their infection and adopt safe sex behaviours. However, it is unclear how the law is perceived. This study explores how HIV(+) youth in Sweden perceive the law, handle their sexuality and disclose their HIV diagnosis to sexual partners. Ten HIV(+) women and men between 17 and 24 years of age were recruited from three different HIV infection clinics. These participants were interviewed in depth. The interviews were tape-recorded, transcribed verbatim and analysed according to a grounded theory approach. The core category-cultured to take responsibility-illuminates the informants' double-edged experiences regarding the law and how they handle disclosure to sexual partners. The legislation implies both support and burden for these HIV(+) youth; they feel that they have a great deal of responsibility, sometimes more than they can handle. 'Switch off lust', 'balancing lust, fear and obedience' and 'switch off the disease' are strategies that describe how the informants manage sexuality and disclosure. Young HIV(+) people have a difficult time informing partners of their HIV diagnosis and discussing safe sex strategies. These are challenges that health care providers need to take seriously. HIV(+) youth need better communication strategies to negotiate safer sex. Staff with extended education on sexuality should be a part of HIV health care.     

The Law of Communicable Diseases Act and disclosure to sexual partners among HIV-positive youth

In Sweden, human immunodeficiency virus (HIV) is included among the venereal diseases covered by the Law of Communicable Diseases Act. HIV-positive (HIV⁺) people are required to inform their sexual partners about their infection and adopt safe sex behaviours. However, it is unclear how the law is perceived. This study explores how HIV⁺ youth in Sweden perceive the law, handle their sexuality and disclose their HIV diagnosis to sexual partners. Ten HIV⁺ women and men between 17 and 24 years of age were recruited from three different HIV infection clinics. These participants were interviewed in depth. The interviews were tape-recorded, transcribed verbatim and analysed according to a grounded theory approach. The core category—cultured to take responsibility—illuminates the informants' double-edged experiences regarding the law and how they handle disclosure to sexual partners. The legislation implies both support and burden for these HIV⁺ youth; they feel that they have a great deal of responsibility, sometimes more than they can handle. ‘Switch off lust’, ‘balancing lust, fear and obedience’ and ‘switch off the disease’ are strategies that describe how the informants manage sexuality and disclosure. Young HIV⁺ people have a difficult time informing partners of their HIV diagnosis and discussing safe sex strategies. These are challenges that health care providers need to take seriously. HIV⁺ youth need better communication strategies to negotiate safer sex. Staff with extended education on sexuality should be a part of HIV health care.     

Auditing the nutrition content of patient charts: one hospital's perspective

Chart audits are traditionally based on patient charts categorized by disease. An alternate approach, using categorization by four types of nutrition care intervention, has been developed by University Hospital. This paper describes the process followed, criteria developed and the results of two complete chart audits. It was shown that nutrition profile forms improved documentation. Overall norms increased significantly from 81.5% to 90% (p < .05). Discussion centres on the evolutionary process from quality assurance to continuous quality improvement.     

Self-disclosure of a HIV-positive serostatus: factors favoring disclosure and consequences for persons living with HIV/AIDS in Burkina Faso

Disclosure of HIV-serostatus remains a way to avoid sexual transmission of HIV because it allows partners to take the necessary protective measures, e.g. use of condoms. Disclosure is nevertheless difficult due to the discrimination associated with HIV. The objective of this study was to analyze factors leading to self-disclosure of HIV-positive status within a sample of persons of both sexes attending different healthcare services in Burkina Faso.MethodologyCross-sectional study conducted by interviewing 740 patients in 26 healthcare services. Univariate (Chi² test) and multivariate (logistic regression) analyses were performed. The significance level was 5%. Qualitative data on factors associated with self-disclosure of HIV-positive status were analyzed.ResultsThe majority of the patients (81.4%) informed at least one person who was very often a close relative (descendant, ascendant and sibling) or the partner. At multivariate analysis, HIV-serostatus was associated with using antiretroviral treatment, (OR = 0.40, 95% CI: 0.3–0.7, P < 0.001), known HIV-serostatus for at least one year (OR = 0.6; 95% CI: 0.4–0.9), living in couple (2.3; 95% CI: 1.4–3.8).ConclusionIn a context limiting HIV testing due to the fear of social stigma, these results appear to be in favor of the Voluntary Counseling Testing model with a focus on the couple and/or families.     

Public disclosure of serostatus -- the impact on HIV-positive people

AIDS is steeped in moral judgments about who becomes infected with HIV. Consequently, an AIDS diagnosis inevitably brings with it feelings of shame, guilt, loss, depression, fear of disclosure and some form of self-imposed isolation. Because of the stigma of an HIV-positive diagnosis, people are often reluctant to come forward and be tested, which makes it difficult for them to make informed decisions about their own future and that of their family. Nevertheless, since early in the epidemic, people living with HIV/AIDS have spoken out to present their personal perspectives on living with HIV and to challenge perceptions about who can and cannot become infected. However, there has been little research to explore their role in the global response to AIDS and the impact of public HIV disclosure on the HIV-positive persons themselves.     

The role of the assessment nurse: one hospital's vision for meeting Joint Commission standards

In evaluating the progress made during one year, it is clear that the position of assessment nurse has been an extremely valuable, effective role. The staff nurses' perception is that they not only understand the importance of the nursing process more thoroughly, but they also view the role of nursing administration as that of trying to help the registered professional nurse at the bedside. It is key in today's health care climate that the nursing administrator be visible. One method to assure visibility is for staff to actually see a role model serving as an extension of the nurse administrator. If nurse administrators truly value the importance of the nursing process, then they need to ensure that this message is being communicated throughout the entire nursing service organization. Such an innovative position can function as a liaison between nursing management and the staff. There is no better method of communicating this than having someone who visibly echoes the values of the nurse administrator. It also should be noted here that Shore Memorial Hospital's Nursing Division received a perfect Joint Commission survey evaluation in April 1990. The Nursing Division attributes this to the efforts made regarding implementation of the nursing process, and the forward thinking of a systems change with implementation of a computerized nursing information system that incorporates the nursing process with everyday documentation. Nurse administrators must effect change and demonstrate leadership within their respective organizations. Organizational change can be slow and difficult at times; however, the end result is worth the effort. It is important that the values of the nurse administrator be disseminated throughout the organization.(ABSTRACT TRUNCATED AT 250 WORDS)