Canadian journal of nursing administration最新文献

This is the final article in a series of three focusing on key management processes in home care. The first article addressed the issue of quality management; the second examined service and human resource issues. This article looks at financial and information management, recognizing that financial management hinges on access to good information. The article focuses on the information issues in home care. It starts by outlining the context that makes the need for home care information critical and discusses some of the issues found in existing information. It then identifies some of the operational, clinical, financial and utilization information needs of home care administrators.

In the midst of downsizing, restructuring, layoffs, hospital closures, mergers, and the beginning cycle of shortages in specialty units, nursing administrators must extend their understanding of the factors influencing job satisfaction and the implications these findings may have for nursing practice, in order to enhance the quality of worklife for nurses in a hospital setting and create competitive work environments. The Causal Model of Job Satisfaction for Nurses (Blegen & Mueller, 1987), including Leatt and Schneck's (1981) technology variable, was the conceptual framework used to look at the effect of the 14 variables (opportunity, routinization, autonomy, job communication, social integration, distributive justice, promotional opportunity, motivation, pay, workload, general training, kinship responsibility, unit size, technology) on job satisfaction. This study demonstrated a statistically significant positive correlation between autonomy, motivation and job satisfaction and a statistically significant negative correlation between routinization and job satisfaction.

The following article describes the process by which a group of acute care nurse practitioners sought to address the legal challenges of working beyond the traditional scope of nursing practice. It was necessary to establish mechanisms for communicating a diagnosis, as well as for ordering diagnostic tests, treatments and procedures. Medical directives were viewed as an approach to address components of practice involving controlled acts not authorized to nursing. The process of developing medical directives began with a description of the components of a medical directive. Algorithms were then developed based on the College of Nurses of Ontario's decision tree (Purvis, 1995) for the performance of procedures. These algorithms were broad and applicable across all clinical programs. The final step, required each nurse practitioner/clinical nurse specialist in collaboration with physician colleagues, to develop individual appendices specific to each clinical program. Health care administrators may find the information provided of assistance in addressing legal concerns that arise when new opportunities for nursing involve movement beyond traditional boundaries.

This article is the second in a series of three focusing on key management processes in home care. The first article addressed the issue of quality management and the next article looks at financial and information management. This article examines the issues of service and human resource management with an emphasis on service management. It starts by outlining some of the pressures behind the unprecedented demand for home care services and looks at a few of the strategies home care agencies can utilize to manage service demand. It then moves to a discussion of human resources, specifically the case manager. Basic qualifications, knowledge, skills, and attributes are outlined and administrators are encouraged to facilitate the ongoing development of this costly and critical resource.

Partnerships will most probably be considered the watchword of the nineties. Their meaning is extrapolated from interviews with individuals involved in creating partnerships of all kinds as well as reviewing selected literature. Criteria for success and common themes found in failure are presented. The relationship between collaboration and partnership is discussed as well as the impact on power bases. Because partnership is fundamentally viewed as a process entailing the development of relationships, two author's views of developmental sequences are compared and contrasted.

Nursing research programs within acute care hospitals are essential to the development and integration of nursing knowledge, difficult to implement and rarely evaluated. The purpose of this paper is three fold: (1) to describe the development, structures, and processes of a nursing research program within an acute care teaching hospital and (2) to describe selected evaluation outcomes and (3) to discuss future directions.

The achievement of an integrated system of care is one of the major goals of Canadian health care restructuring. Although many of the structural barriers to service integration have been removed, integration of care for individuals with long-term, complex health and human needs has not yet been achieved. Case management is now being considered in many countries as a method of integrating and coordinating health and social service systems. Central to the effectiveness of case management is the role of the case manager. The case manager provides clients with continuity, consistency, and coordination of care across all clinical settings and boundaries. Comprehensive case management practice requires professionals with the knowledge and skills to work within existing bureaucratic and organizational service systems. This article is a summary of the literature on long-term care case management, with a focus on Canadian studies.