Mobile computing in critical care

Handheld computing devices are increasingly used by health care workers, and offer a mobile platform for point-of-care information access. Improved technology, with larger memory capacity, higher screen resolution, faster processors, and wireless connectivity has broadened the potential roles for these devices in critical care. In addition to the personal information management functions, handheld computers have been used to access reference information, management guidelines and pharmacopoeias as well as to track the educational experience of trainees. They can act as an interface with a clinical information system, providing rapid access to patient information. Despite their popularity, these devices have limitations related to their small size, and acceptance by physicians has not been uniform. In the critical care environment, the risk of transmitting microorganisms by such a portable device should always be considered.     

Portable computers and applications in respiratory care

Personal digital assistants (PDAs) have had a tremendous impact in the clinical setting, as they have in business and education environments. This report explores the health care application of PDAs, compares available PDA devices and software, and discusses PDA use for tracking patients, documenting clinical procedures, medical education, research, and accessing medical reference material. This report aims to increase awareness among health care providers about the potential roles of PDAs and to encourage further evaluation of PDAs in respiratory care.     

Innovative solutions: a collaborative effort of critical care oncology: the common ground of tubes and lines.

The intensive care units and the oncology units at Banner Good Samaritan Medical Center are for complex patients who require multiple and diverse venous access devices. The critical care clinical nurse specialist and the oncology/bone marrow transplant clinical nurse specialist collaborated to create a reference sheet for nurses regarding the care and maintenance of venous/arterial access devices.     

Access to mental health care among older adults

Many older adults experience common mental health problems that can have a negative impact on physiological health, functional status, and quality of life. Lack of access to mental health care for community-dwelling older adults is a significant problem. Busy primary care practices, few mental health professionals, inadequate problem recognition, and flaws in the health care system all contribute to restricted access to mental health care. As the population of adults 65 and older continues to grow, the need for mental health care for this group will increase. Strategies to improve access to mental health care must be targeted at the individual level, the provider level, and the system level.     

Preservation of vascular access for hemodialysis in acute care settings

A vascular access for hemodialysis is the client's lifeline. It must be protected and used only for hemodialysis. Clients are knowledgeable about their vascular access and need to be listened to about its care. These clients' greatest fear is that their vascular access will be damaged and rendered nonfunctional. All health care personnel who come in contact with the vascular access and the client need to properly care for the vascular access with the goal of preserving its function. The purpose of this article is to explain the different types of vascular access for hemodialysis and how nurses can preserve and care for them. The vascular access and adjacent body areas need to be assessed regularly for circulatory, neurological, and muscular functions. Adequate perfusion helps to preserve the vascular access. Clients with end-stage renal disease will undergo many invasive procedures to establish and maintain a vascular access. Therefore, it is important to preserve the integrity of the existing vascular access as well as the surrounding vessels for future accesses. Nurses in acute care settings can assist to reduce the human and economic burden of vascular access.     

Critical access health care: a concept analysis

PURPOSE. The purpose of this paper is to provide a concept analysis of critical access health care. A common understanding of critical access health care would benefit those who legislate, provide, and consume health care. METHODS. A review of the literature was conducted using an identical set of search terms that yielded a variety of sources; however, none were specifically related to critical access health care. FINDINGS. No literature of concept analysis of critical access health care could be found. CONCLUSIONS. A concrete and measurable understanding of the concept will provide a common foundation to assist public and private entities in developing viable methods to understand healthcare policies, problems related to access, disparities in health care, and ways to increase health promotion and disease prevention.     

Comparison of adolescent health care provided at a school-based clinic and at a hospital-based pediatric clinic

Adolescents are an underserved population lacking adequate access to health care. School-based clinics have been promoted as one strategy to improve both access and care. We studied the degree to which such clinics provide services that either differ from or complement conventional health care service. Six categories of primary diagnoses were collected from adolescent visits to a high school clinic and from a nearby hospital-based pediatric clinic, both serving an indigent, predominantly Hispanic, inner-city community. Comparison of patterns of clinic utilization showed that the school-based clinic received significantly more visits for counseling and health care maintenance, while the pediatric clinic received more visits for acute and chronic illnesses. The school-based clinic appeared to improve access to health care for adolescents by allowing confidential visits for issues less easily addressed at more conventional health care sites.     

Surgical procedures and devices should be evaluated in the same way as medical therapy

This paper is a personal essay that starts and ends with the message that surgical procedures and devices should be evaluated in the same way as medical therapies, namely, by randomized clinical trials (RCTs). I discuss, with particular attention to surgical procedures and devices, the objections raised against RCTs in medical decision-making, a schema for utilizing the traditional phases of RCTs in the evaluation of surgical procedures and devices, the importance of RCTs to FDA approval, financial compensation, and health care costs, the impact of RCTs on clinical practice, the role of RCTs in academia, teaching, and research, and the surgeon's obligation to participate in a leadership role in RCTs. The belief is expressed that national funding of health care should mandate allocations for RCTs and that such expenditures, as well as the spending of health care dollars on the basis of the outcomes of such trials, will not only improve patient management in the shortest time but will eventually reduce health care costs. The RCT, by selecting effective and safe surgical procedures and devices, as well as diets and drugs, is the best means science has to assess the validity of patient management.     

Disparities in cardiac care for patients with complex cardiovascular care needs

The United States continues to have a prevailing public health problem related to disparities in healthcare. Factors contributing to disparities include ethnicity, gender, socioeconomic status, educational level, geographic location, and hospital characteristics. In cardiovascular care, gaps in care have been associated with lack of conformity to evidence-based therapies known to improve clinical outcomes, including survival, quality of life, and freedom from rehospitalization. Specifically, there are disparities in use of a number of cardiovascular life-saving procedures including cardiac catheterization, percutaneous coronary intervention, coronary artery bypass surgery, and implantation of defibrillators and cardiac resynchronization devices. The purpose of this article was to illustrate the range of disparities that exist in relation to management of patients with acute coronary syndromes, interventional cardiology procedures, cardiac surgery, heart failure, and device implantation. Because the impact on patient outcomes is high, potential interventions to address disparities will be provided.     

Health maintenance alteration: a nursing diagnosis of the elderly

The continually growing numbers of elderly persons in our society and the corresponding increase in health care needs for those over age 65 are providing significant challenges to the health care delivery system. Diminishing health care resources and a desire to avoid institutionalization of the elderly client are creating nursing roles for helping the elderly maintain healthful living within the community. Accurate assessment provides the nurse with access to client perceptions of health status as well as a picture of the health management practices of the older adult. A nursing diagnosis of health maintenance alteration is the basis for an individualized plan of care of nursing intervention which is directed toward reducing risk factors and assisting the elderly client to achieve optimum levels of function and independence within the limits of defined health maintenance alterations.     

Sharps injuries in the home health care setting: risks for home health care workers.

Home health care nurses are at risk of needlesticks and blood exposures, yet few studies have been conducted related to such exposures in the home health care setting. This article describes a cross sectional prevalence pilot study of needlesticks and blood exposures conducted among three home health care agencies in the San Francisco Bay area. Needlestick and blood exposure reports from 1993 to 1996 were submitted from three home health care agencies. The exposures were categorized using an existing categorization system and compiled into a composite report. A total of 52 exposures occurred; nurses sustained 92% of exposures. Twenty-three percent occurred before, during, or after needle disposal; 17% from manipulating intravenous/access ports; 15% from improper disposal; and 13.5% during or after blood draw. Needle safety devices need to be specifically designed for the unique home health care setting and for a standardized rate of calculating needlestick injuries in this setting.     

The care of vascular access devices in community care

Infusion therapy is now an integral part of the majority of nurses' professional practice (RCN, 2006). Infusion therapy is no longer confined to secondary care, and home intravenous therapy is becoming more commonplace (Keyley, 2002). As nurses, we are responsible for maintaining our skills and knowledge in relation to all aspects of patient care (RCN, 2006). This article provides an overview of the types of vascular access devices used in primary care, and provides guidance and recommendations to ensure best practice. Although there are many complications associated with vascular access devices (Docherty, 2006) this article will focus on the prevention of infection and maintainace of catheter patency in vascular access devices. Infection is one of the most serious complications that can result from the presence and use of a central venous catheter (Humar et al. 2000), however careful management of these devices can minimize the complications associated with infusion therapy.     

Medicare health maintenance organizations and traditional coverage: perceptions of health care among beneficiaries with disabilities

OBJECTIVE: To determine whether perceptions of access to, affordability of, and quality of health care services differ for Medicare beneficiaries with disabilities in health maintenance organizations (HMOs) and traditional Medicare coverage. DESIGN: Bivariate and multivariate analyses were conducted to determine the relationship between Medicare coverage type and perceptions of health care access, affordability, and quality. SETTING: Noninstitutionalized Medicare beneficiaries across the United States. PARTICIPANTS: A random sample of 6116 beneficiaries who qualify for Medicare as working-age disabled (n = 2250), or who qualify as elderly and have at least 1 instrumental activities of daily living limitation (n = 3866). This subsample of the nationally representative Medicare Current Beneficiary Survey (MCBS) represents 11,627,107 beneficiaries with disabilities. INTERVENTION: Questions about perception of access to primary care, affordability of care, and quality of care. Data derived from the 1994 MCBS Access to Care File. MAIN OUTCOME MEASURES: Dependent variables: perceptions of access to primary care, affordability, and satisfaction with quality of care. Independent variables: indicators of managed care status and health status level, severity of disability, Medicare qualification, age, and gender. RESULTS: Beneficiaries with disabilities in HMOs perceive better access to primary care services, and greater affordability of health services than those with traditional Medicare coverage. Beneficiaries in poor health or with the most severe disabilities were most likely to perceive access and cost difficulties, regardless of coverage type. CONCLUSION: Medicare managed care appears generally to be meeting 2 of its goals-better access to primary care and more affordable care-though these advantages are not being shared by those with poor health status and/or severe disabilities.     

Reframing resilience: Strengthening continuity of patient care to improve the mental health of immigrants and refugees

Refugee and immigrant populations experience many pre‐ and post‐migration risk factors and stressors that can negatively impact their mental health. This qualitative study aimed to explore the system‐level issues that affect the access to, as well as quality and outcomes of mental health care for immigrants and refugees, with a particular focus on challenges in the continuity of patient care. A multidisciplinary group of health providers, including nurses, identified six themes including (i) perceived access to care; (ii) coordination amongst health care providers; (iii) patient connections with community organizations; (iv) coordinated care planning; (v) organizational protocols, policies and procedures and (vi) systemic and health care training needs. Although patient resilience is seen as a pivotal way for vulnerable populations to cope with hardship, there is a clear need for creating a resilient health care system that is able to anticipate and adapt to adverse situations. The findings from this study have implications for nurses, who are uniquely positioned to advocate for public health policy that improves the continuity of health care by creating systemic resilience.     

Primary care health issues among men who have sex with men

PURPOSE: The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. DATA SOURCE: Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. CONCLUSIONS: There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. IMPLICATIONS FOR PRACTICE: Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM.     

Integrating mental health and primary care

Mental health and primary care delivery systems have evolved to operate differently. For example, attention to multiple medical issues, health maintenance, and structured diagnostic procedures are standard elements of primary care rarely incorporated into mental health care. A multidisciplinary treatment approach, group care, and case management are common features of mental health treatment settings only rarely used in primary care practices. Advances in treatments for mental health disorders and increased knowledge of the integral link between mental health and physical health encourage mental health disorder treatment in primary care settings, which reach the most patients. Effective integration of mental health care into primary care requires systematic and pragmatic change that builds on the strengths of both mental health and primary care.     

Central venous catheters: preventing infection and occlusion

As central venous catheters (CVCs) become more widely used in today's healthcare environment, nurses require expert knowledge in relation to CVC maintenance to prevent complications and maximize efforts to optimize the individual's health status. This is especially so since CVCs have begun to be used outside intensive care units, e.g. in general wards, and can be associated with high incidences of infection, occlusion and subsequent compromise in patient health. Nurses are responsible for the maintenance and use of central access devices, such as CVCs, resulting in a need for literature specific to the nursing aspects of CVC management. This article addresses many nursing issues pertaining to care of the central line, focusing on evidence- and research-based literature, and also reviews the literature to make recommendations for practice.     

Restructuring the American health care system: an analysis of Nursing's Agenda for Health Care Reform.

Equal access to health care for all citizens is a hotly debated issue of the American health care system. Different plans for reform that would allow equal access to health care have been proposed, but few include nurses as key health care providers. To correct this oversight, a coalition of more than 60 national nursing and health care organizations has created Nursing's Agenda for Health Care Reform, a blueprint for restructuring the health care system. This article reviews the agenda within the framework of the ethical theory of distributive justice. Distributive justice allows for the allocation of health care resources in a manner that is fair but not necessarily equal for all. The agenda addresses the basic level of health care needed by all Americans and supports the provision of primary care by nurse practitioners. Nurse practitioners need to be aware of plans to reform the health care system and should be supportive of those plans that enhance nurse participation in the health care system. Nursing's Agenda for Health Care Reform is a plan that encourages the health care consumer's participation and promotes nursing care as the link between the consumer and the health care system.     

Kangaroo mother care: A literature review of barriers and facilitators to implementation in the neonatal intensive care unit

Kangaroo mother care (KMC) is a cost-effective, natural, safe, and evidence-based intervention that improves maternal-infant bonding, increases breastfeeding rates, and decreases the risk of mortality and morbidity in preterm infants. Although KMC is recommended to be the standard of care for preterm infants, there are significant implementation barriers. This literature review critically analyzes the barriers and facilitators to implementation from three health care system components: (1) health care facilities, (2) health care providers, and (3) parents. One independent author included 17 research-based articles from 2014 to 2021. Overarching themes identified were: availability of protocols, policies, and guidelines; access to training and support; access to resources; buy-in; and medical concerns. Recommendations to overcome barriers and increase uptake are: develop and disseminate KMC protocols, policies, and guidelines; provide quality training and support to health care providers; provide quality education and socio-cultural support to parents; and allocate resources to support KMC.