Regional health care systems: implications for health care reform

Not only should there be payment reform, but health care delivery should be redesigned to achieve the triple goals of access to services, quality improvement, and cost control. The authors review the forces that have formed multihospital and health care systems in the past, and the seven stages that health care systems traverse toward competency. They briefly discuss the implications of those realities for reform implementation. One premise is that the natural evolution of such health care systems toward competency will take a longer time than most nonproviders expect.     

The changing focus of health care ethics: implications for health care professionals

Contemporary health care ethics has become preoccupied with the issue of people's rights to and in health care (eg the rights to informed consent, confidentiality, quality of life, death with dignity, etc). There is no question that this preoccupation has achieved some morally significant and beneficial outcomes in health care domains. Nevertheless, it is evident that health care ethics has not achieved its most basic task, namely, to promote and protect the genuine wellbeing and welfare interests of those who are among the most vulnerable people in society and whose health status is at risk. A key contention of this paper is that if health professionals are going to be able to meet future moral challenges posed by the complex question of human health, then the nature, aims, purpose, significance, and modus operandi of contemporary health th care ethics needs to be revisited, re-visioned, and revitalised.     

A survey of the health needs of hospital staff: implications for health care managers

Developing strategies to address the health needs of the National Health Services (NHS) workforce are of concern to many health care managers. Focal to the development of such strategies are of being in receipt of baseline information about employees expressed health needs and concerns. This article addresses obtaining such baseline information and presents the findings of a health needs survey of acute hospital staff in a trust in North Wales. The total population of trust employees were surveyed (n = 2300) and a 44% (n = 1021) response rate was achieved. A number of positive findings are given. Included are that the majority of those surveyed stated that their current health status is good, are motivated to improve their health further, do not smoke and their alcohol consumption is within recommended levels. There appears, however, to be a number of areas where trust managers can help its staff improve their health. Included are trust initiatives that focus on weight control and taking more exercise. In addition, there appears to be a reported lack of knowledge and positive health behaviour amongst the male respondents surveyed that would imply the trust needs to be more effective in promoting well man type issues. Finally there appears to be a general lack of pride in working for the trust and a pervasive feeling that the trust does not care about its employees that needs to be addressed. It is concluded that the findings of this survey have implications for management practices in the trust where the survey was conducted and also wider applicability to the management of health care professionals. For example, addressing work-related psychological and physical problems of employees are of importance to all health care managers. This is especially so when considering recruitment and retention issues.     

Adolescence: implications for preventive health care in schools

Adolescence is a pivotal period in an individual's life characterized by rapid growth and developmental changes that ultimately lead to an individual's self-identity as a contributing member of society. A review of this critical period of growth and development clearly defines the increased health risks and potential health problems of adolescents. To effectively impact these health needs, this article purports the value of preventive health services provided in the school setting. One urban school health services model is discussed as an example of effective preventive health care.     

Advocacy and nursing: implications for women's health care

A recent government report indicates that women in Victoria are dissatisfied with the health care they receive. Advocacy is presented as a core concept which could be utilized by nurses to effect change in women's health care. Some models of advocacy in the nursing literature are examined and related to the aims of the women's health movement. The model of patients' rights advocate appears to have the greatest congruence with the aims of this movement and could be adopted by nurses to improve women's experience of the health care they receive.     

The health of female child care providers: implications for quality of care

The purpose of this investigation was to determine the health behaviors and perceived health status of child care providers. Health behaviors and health status were also examined in relation to caring for children and the providers' perceptions of quality child care. A researcher-developed questionnaire, adapted from Williams, Mason, and Wold (2001), was mailed to a random sample of 1,000 child care providers employed in 49 child care centers in Georgia. Results indicated that, overall, the sample was a healthy population with 86.8% rating their health as good to excellent. Seventy-three percent (73%) received a physical exam annually, and 70% reported having health insurance. Despite these ratings, participants reported that they were overweight, were emotionally strained, and did not engage in physical exercise at least 3 times per week. Although most performed breast self-exams, the majority did not fully understand breast health practices. Furthermore, the majority of the child care providers (78.7%) believed that their health does not impact the care that they provide to children. Last, their definitions of quality of care for children suggested a minimal standard of care or less. These findings provide information that can be useful in designing occupational health programs within community child care settings and in promoting healthy behaviors in women.     

Psychiatric diagnosis: some implications for mental health nursing care

This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.     

Foster child health and development: implications for primary care

Children in foster care are the most vulnerable to experiencing poor health compared with any other group of children in the United States. Children enter foster care due to experiences that have been detrimental to their health and well-being, including child abuse and neglect. They have significantly higher rates of all health problems than the general population of children, including acute and chronic illnesses, growth and developmental problems, serious mental health problems, and difficulties accessing health services. Additionally, they often experience multiple foster care placement transitions, involvement in multiple systems of care (e.g., mental health, juvenile justice, special education), and aging-out of foster care at age 18 before they are developmentally ready for independent living. While management of the complex health and developmental needs of these children is challenging, nurses in primary care have the expertise and obligation to serve these vulnerable children. Priorities for clinical practice include care coordination and interdisciplinary collaboration; maintenance of adequate, up-to-date health records; vigorous follow-up; and health-targeted advocacy.     

Psychiatric diagnosis: some implications for mental health nursing care

Psychiatric diagnosis: some implications for mental health nursing care This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.     

Social support: some pragmatic implications for health care professionals

The role of social support in promoting recovery from chronic illness has been the focus of a debate within the nursing and social science research communities This paper reviews the literature on this important issue and discusses the implications for patient management In providing holistic patient care, health care professionals need to reflect on the impact of this research for their clinical practice     

Nursing and health care reform: implications for curriculum development

The health care system is undergoing profound changes. Cost containment efforts and restructuring have resulted in cutbacks in registered nurse (RN) positions. These changes are often related to the increased market penetration by managed care companies. To determine how RN graduates perceive these changes and their impact on the delivery of patient care, Healthcare Environment Surveys were mailed to graduates of the classes of 1986 and 1991. Using the Survey's 5-point Likert Scale, we measured the graduates' satisfaction with their salary, quality of supervision they received, opportunities for advancement, recognition for their job, working conditions, the overall job and the changes in their careers over the previous five year period. Our study suggests that the changes in the health care system are having an impact on how health care is being delivered and the way nurses view their jobs. Respondents reported that insurance companies are exerting increased control over patient care and perceive that the quality of patient care is declining. Increased workloads and an increase in the amount of paperwork were reported. Participants perceived that there were fewer jobs available and that job security was decreasing. The percentage of nurses who see job satisfaction as remaining the same or increasing are a majority. However, the relatively high percent of nurses who see job satisfaction as declining should provide a note of warning. The major implications of this study are that the professional nursing curriculum must be modified to include content on communication, organization, legislative/policy skills, and leadership. The nation's health care system is undergoing profound changes. There are numerous forces at work that are effecting the delivery of care and, consequently, the work of health professionals. These forces include significant efforts at cost containment, restructuring and downsizing of hospitals, and the movement of health care delivery out of acute care centers and into the community. Even though cutbacks in registered nurse (RN) positions appear to have leveled off in sections of the country that have gone through restructuring and reengineering of the work place, there still remains a heavy emphasis on lowering costs by decreasing employee benefits and increasing productivity through the substitution of part-time RNs for full-time RNs and the substitution of unlicensed assistive personnel (UAP) for RNs. These changes are often related to the increased market penetration by managed care companies, which are not expected to abate any time soon. It is important to determine what impact these changes are having on the delivery of patient care since there is some evidence to suggest that reduction in nursing staff below certain levels is related to poor patient outcomes (Fridken et al, 1996). It is also important to assess the effect of system changes on the satisfaction level health professionals have in their jobs. This is particularly important since some researchers suggest that job dissatisfaction, over a period of time, can result in burnout and eventually, turnover (Cameron, Horsburgh, & Armstrong-Stassen, 1994; Cotterman, 1991). Finally, understanding the impact of these health care delivery system changes has significant implications for baccalaureate nursing education and the preparation needed by future nurses to help them adjust to the changed environment.     

Technology's implications for health care quality. A clinical engineering perspective

Bill Gates states in Business @ The Speed of Thought that "the 2000s will be about velocity." This "decade of velocity" is driven by the flow of digital information. Health care organizations should develop a "digital nervous system" that is distinguished from a network of computers by the accuracy, immediacy, and richness of the information it brings to health care workers and by the insight and collaboration made possible by this information. This article provides a clinical engineering perspective on technology in health care in an era of rapid change. It discusses how clinical engineers work with health care professionals to manage and adapt to technological, economic, social, and regulatory forces that are redefining our approach to health care delivery.