Physicians' capability in home health practice: home health nurses' perceptions.

OBJECTIVES: To examine home health nurses' attitudes towards physician capabilities in home health care, and whether nurses' attitudes are associated with their experience, practice setting, degree of physician interaction, or use of home health guidelines. DESIGN: A multiple regression analysis of a 90 item survey on agency characteristics, degree of interaction with physicians, and ratings of physicians capabilities across multiple dimensions of home health practice. SETTING/PARTICIPANTS: 86 registered visiting nurses from seven Chicago-area home health agencies, who averaged 25 home visits and over one hour of direct contact with physicians weekly. MEASUREMENTS: Nurses' ratings of physician capability in home health practice were scaled from 18 survey items with high internal consistency reliability and correlated with nurses' practice characteristics. RESULTS: While most nurses (72%) felt that physicians responded adequately in emergencies and respected them as colleagues (70%), over 70% of respondents did not agree that physicians were adequately trained in home health. A majority of respondents rated physicians negatively on patient education, cross-coverage and availability, discharge planning, support and medical supply services, and insurance issues. Respondents' years of home health experience correlated negatively (p = .004) and degree of contact with physicians correlated positively (p = .05) with ratings of physician capabilities. CONCLUSION: Nurses' attitudes about physicians' performance can provide important insights for improving the effectiveness of specialized disease and outcomes management programs which rely on care in the home setting.     

Gender and power: Nurses and doctors in Canada

BACKGROUND: The nurse-doctor relationship is historically one of female nurse deference to male physician authority. We investigated the effects of physicians' sex on female nurses' behaviour. METHODS: Nurses at an urban, university based hospital completed one of two forms of a vignette-based survey in January, 2000. Each survey included four clinical scenarios. In form 1 of the questionnaire the physicians described were female, male, female, and male. In form 2, vignettes were identical but the physician sex was changed to male, female, male, and female. Differences in responses to questions based on the sex of the physician in each vignette were studied RESULTS: 199 self-selected nurses completed the survey. The responses of 177 female respondents and 11 respondents who did not specifiy their sex, and were assumed to be female based on the overall sex ratio of respondents, were analysed. Persistent sex-role stereotypes influenced the relationship between female nurses and physicians. Nurses were more willing to serve and defer to male physicians. They approached female physicians on a more egalitarian basis, were more comfortable communicating with them, yet more hostile toward them. CONCLUSION: When nurses and doctors are female, traditional power imbalances in their relationship diminish, suggesting that these imbalances are based as much on gender as on professional hierarchy. The effects of this change on the authority of the medical profession, the role of nurses, and on patient care merit further exploration.     

Hospital nurse counseling of patients who smoke.

Smoking-related diseases comprise a large portion of hospital admissions. This paper reports the attitudes and behaviors of a group of hospital-based nurses toward counseling patients on smoking cessation. The majority of nurses do not counsel patients who smoke. Counseling practices vary with the smoking status of the nurse. Barriers to increased nursing participation in counseling efforts include the lack of counseling training and physician failure to utilize nurses in this role.     

Involving physicians in TQM. To gain physician support for quality management, hospital administrators must treat physicians as customers

The process of integrating physicians into a hospital's total quality management (TQM) program is not simple. Physicians will not view TQM as an acceptable strategy in the absence of a positive working relationship with hospital managers. Physicians must see hospital managers as colleagues who can help improve their medical practices both in efficiency and patient care. The first step in involving physicians in TQM is creating an environment that enhances physician relationships. The CEO should be actively involved with the medical staff, and senior hospital managers should work at cultivating physician relationships. Physician needs and the centrality of the physician-management relationship should enter into every management discussion. Also, managers must solicit physician feedback regularly. Managers can introduce physicians to TQM by accompanying them to off-site TQM programs for a few days. Managers should also coordinate a continuing education program at the hospital, inviting a physician to address medical staff about TQM. Physicians are more likely to respond positively to one of their peers than they would to a consultant or business manager. Managers should then invite hospital-based physicians to participate on TQM interdisciplinary teams to resolve a problem chosen by the senior medical staff. The problem should be one that promises to be a quick fix, thereby ensuring demonstrable success of TQM and allaying any doubts. After an initial demonstration of TQM's success, the cycle is repeated. A year or two later, managers should invite off-site clinicians to join interdisciplinary teams on issues important to them.     

Evolving the delivery of acute care services in the home

To serve escalating acute care caseloads, physicians affiliated with one Canadian home care program have piloted a project to integrate physician services into the home (IPSITH). This paper presents the 18-month qualitative evaluation. Phenomenological methodology and in-depth interviewing were used to construct a holistic interpretation of the implementation from the experiences of all involved: patients, family caregivers, physicians, case managers, community nurses and the project's nurse practitioner. Findings revealed the central role of the nurse practitioner, who served as a clinical expert, care coordinator and case manager. Several unsolved issues were identified: the extent to which home care is a viable alternative to hospitalization, the feasibility of physician involvement, redundancies with hospital emergency services, and the limitations of system resources for funding such services. The researchers conclude that full-scale long-term integration of physician services in the home may require macro-level decisions about system design, resource allocation, and professional regulations.     

The role of nursing in bridging the gap between managers and physicians in hospitals

Tension between hospital managers and physicians is at an all-time high. This article builds on a previous work on the culture of managers and physicians and suggests that nurses can play an instrumental role in bridging the gap between these 2 cultures. Several similarities appear between managers' and nurses' cultures, other similarities can be found between physicians' and nurses' cultures, whereas nurses' culture seems to fall somewhat in the middle of the continuum on some other cultural aspects. Therefore, we suggest that nursing can and should play a crucial role in bridging the gap between the worlds of management and medicine. In a way, nurses can act as "translators," who can explain physicians' views to managers and vice versa. Practically, this will mean a better-defined role for nurses in key hospital committees and task forces, a more active role of the chief nursing officer in the Chief Executive Officer-Chief Medical Officer, and, more importantly, better representation of nurses on hospital boards that already have physician members.     

Attitudes and intentions of future health care providers toward abortion provision

CONTEXT: Induced abortion is one of the most common procedures performed among women in the United States. However, 87% of all counties had no abortion provider in 2000, and little is known about the attitudes and intentions of future health care providers, including advanced clinical practitioners, regarding abortion provision. METHODS: During March 2002, first- and second-year students in health sciences programs (i.e., medicine, physician assistant and nursing) at the University of Washington were anonymously surveyed. Univariate, bivariate and multivariate analyses were used to determine students' attitudes and intentions regarding provision of abortion services. RESULTS: Of the 312 students who completed the survey, 70% supported the availability of legal abortion under any circumstances. Thirty-one percent intended to provide medical abortion in their practice, and 18% planned to offer surgical abortion. Fifty-two percent of all respondents agreed that advanced clinical practitioners should be able to provide medical abortion, and 37% agreed that they should be able to provide surgical abortion services; however, greater proportions of advanced clinical practitioners (45-83%) than of medical students (21-43%) expressed such support. Sixty-four percent of all respondents were willing to attend a program whose curriculum requires abortion training. CONCLUSIONS: Although it may not be possible to require abortion training for every future health care provider, making abortion a standard part of clinical training would provide opportunities for future physicians and advanced clinical practitioners, and would likely ameliorate the abortion provider shortage.     

Contraceptive method continuation according to type of provider

A study was undertaken at the main PROFAMILIA clinic in Bogota, Colombia to compare the effectiveness of nurses and physicians in the delivery of family planning services. Contraceptive method continuation was the major outcome variable in this analysis. Clients were randomly assigned to physicians or nurses on their first visit and for the duration of care. On all revisits, data were collected pertaining to method prescribed, side effects, pregnancy, and method changes. There was a field survey at eight months to locate clinic drop-outs and determine their contraceptive use status. There were no significant differences in method continuation between clients who received services from physicians and those who received services from nurses. At nine months, the overall continuation of the first method prescribed was 79.1 per cent in the physicians' group and 75.8 per cent in the nurses' group (t = 1.057, p greater than .20). When controlling for first method used, the IUD users in the physicians' group had a continuation rate of 86.1 per cent and in the nurses' group 84.0 per cent (t = 0.556, p greater than .50). Of the pill users who received services from physicians, 78.1 per cent were continuing at nine months and 74.3 per cent of the pill clients in the nurses' group were continuing at nine months (t = 0.573, p greater than .50). There were no differences in pregnancy rates, side effects rates, and method change rates between the two groups. It may be concluded that these nurses were as effective as physicians in the delivery of family planning services.     

Access to Health Care for Undocumented Migrant Children and Pregnant Women: The Paradox Between Values and Attitudes of Health Care Professionals

Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children’s rights are needed to promote equitable practices and advocacy against regulations limiting services.     

Productivity and quality of public hospital medical staff: A dominican case study

Medical care personnel constitute a major portion of health-care costs and are an important determinant of quality. Personnel policy, especially regarding physicians and nurses, is central to the level and type of care provided, and ultimately to the resources expended. There is increasing evidence that state health systems in many Latin American countries face the apparently paradoxical situation of oversupply of physicians coupled with the undersupply of physician services. Yet, productivity of medical staff in public facilities in Latin America is a relatively unexplored area. Further, little is known about the relationship between productivity of medical staff and quality of services provided in developing countries. Taking the case of a large public hospital in the Dominican Republic, this study examines the quality of hospital structure and process as it relates to the functions and performance of physicians, and to a lesser extent, nurses. Based on a patient-based survey, data were collected on physician and nurse time allocations in outpatient, emergency, surgery and inpatient wards, the types of services provided, and the time costs of providing them. The analysis focuses on medical staff performance according to the professional levels of physicians and nurses providing care, and the time spent attending to patients and conducting supervisory tasks. The gap between contracted and expended physician hours is examined. The paper concludes with a discussion of the policy implications for hospital management, particularly as they relate to incentives for medical personnel.     

Nurses' perceptions of inter- and intra-professional relationships: an analysis of support from nursing and physician colleagues in rural hospitals.

Nurses employed in ten rural hospitals in Canada completed questionnaires designed to examine their perceptions of the strength of the professional relationship which existed among nurses and between nurses and physicians. Four questions addressed the availability of nursing education programs and the attendance of nurses and physicians at such programs. Seven questions examined the nurses' perception of physician interest in nursing education and the encouragement received from their nursing colleagues to participate in learning activities and medical management decision making. Chi square analysis was undertaken to determine whether the colleagial relationships differed by hospital or medical staff characteristics. Forty percent of the nurses felt that the majority of of physicians were supportive of continuing nursing education. Sixty-three percent indicated their nursing colleagues encouraged them to attend educational programs. The results indicate that physician participation in nursing continuing education was greatest in communities with the fewest health resources (an acute hospital with fewer than 50 beds). In contrast, encouragement to participate in continuing nursing education was highest in settings where the hospital provided both acute and extended care services, had more patient admissions and a greater availability of educational programming.     

Day Care Center Directors'' Perceptions of the Nurse Consultant''s Role

Forty-nine day care center directors were surveyed to examine their perceptions of the nurse consultant's role. Findings revealed the directors were positive but indiscriminate about the scope of nursing practice. Many respondents were unable to identify the nurse consultant's educational background or specialization. Without an accurate understanding of nurses' abilities, day care centers may not use the full range of health services that nurses offer.     

Attitudes to the use of videoconferencing in general and specialist psychiatric services

Mental health professionals and support staff were invited to complete a questionnaire about their experience of using videoconferencing. Our hypotheses were that mental health professionals in the UK do not have access to videoconferencing and do not believe that videoconferencing is appropriate for their work. Of the 134 people who completed and returned a questionnaire, 78 worked in deaf mental health services and 56 worked in general mental health services. The majority were nurses (n = 33) or psychologists (n = 30). A total of 109 respondents (81%) knew what videoconferencing was, but only 16 respondents (12%) had ever used it. The majority of the 32 respondents who knew the location of their nearest videoconferencing facility said that it could be accessed in less than 30 min. The 16 people who had previously used videoconferencing identified four different benefits of videoconferencing and eight different drawbacks. We conclude that mental health staff did not have adequate knowledge of, or access to, videoconferencing.     

Partnership working by default: district nurses and care home staff providing care for older people

Older people residents in care homes that only offer residential care rely on primary healthcare services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary healthcare team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on‐site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community‐based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community‐based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.     

An investigation of causes of patient satisfaction/dissatisfaction with physician services

To provide the highest level of satisfaction, health care providers must control patients' expectations and perception of treatment quality. This study is designed to gain insight into the perception and attitudes of consumers toward physician services. It attempts to examine the satisfaction/dissatisfaction of patients in association with the cost and quality of medical care; interpersonal skills, competence and professional recognition of physicians; information provided and attention given by physicians; waiting time, physical facilities, and receptionists and nurses in the physicians office. Data was gathered using telephone interviews from a sample of 245 respondents. Factor analysis techniques in the SPSSX software package were used in data analysis. Findings indicated that there are generally favorable attitudes toward the quality of medical services, and that medical cost has secondary importance.     

Physicians vs. auxiliary nurse-midwives as providers of IUD services: a study in Turkey and the Philippines

Several studies have shown that nurses, nurse midwives, and paramedical personnel can provide satisfactory IUD services, but restrictions are still placed upon their provision of these services. A randomized trial of auxiliary nurse midwife and physician IUD services was conducted among 495 interval acceptors in Turkey and 510 postpartum acceptors in the Philippines between 1976 and 1979 to further evaluate this question. Discontinuations due to expulsion, removal, and pregnancy were comparable for physician and nurse midwife clients. Among Filipino women who experienced an early expulsion, nurse midwives reinserted a device in significantly more cases (54.5%) than physicians (31.3%). The diagnosis of contraindications or complications were similar in the 2 groups. Turkish women frequently refused to have pelvic examinations by male physicians, and in the Philippines, nurse midwives provided better follow up than physicians. It is concluded that auxiliary nurse midwives can provide clinical services comparable to those provided by doctors, and may give better continuity of care because they are more accessible and acceptable to clients.