Canadian journal of nursing administration最新文献

General hospital mental health programs in large inner city communities face challenges in developing responsive services for populations facing high rates of serious mental illness, substance abuse, homelessness, and poverty. In addition provincial political pressures such as Mental Health Reform and hospital restructuring have caused general hospital mental health programs to reevaluate how services are delivered and resources are allocated. This paper describes how one inner city mental health service in a university teaching setting developed successful strategies to respond to these pressures. Strategies included: (a) merging two general hospital mental health services to pool resources; (b) allocating resources to innovative care delivery models consistent with provincial reforms and community needs; (c) fostering staff role changes, job transitions, and the development of new professional competencies to complement the innovative care delivery models; and (d) developing processes to evaluate the effects of these changes on client.

This study highlights some of the issues for preceptors and assists in clarifying the role of preceptors, students and nurse educators. Through a survey of 295 nursing preceptors in the province of Alberta, it was found that most preceptors rated their orientation to their role as adequate to very adequate, the greatest advantage was re-examining their knowledge and the most common problem was having a student with poor nursing skills. Only 30 percent used nursing frameworks. The implications are: nursing educators need to take more responsibility in the areas of preceptor and student orientation, assess the student, preceptor and agency prior to placement, and understand that the preceptor may not be using a nursing framework. Nurses working as preceptors do have the advantage of knowledge since working with students can be a form of continuing education. This study highlights some of the issues for preceptors and assists in clarifying the role responsibilities of preceptors, students and nurse educators.

During the last two decades, knowledge has increased significantly regarding the treatment of acute pain. One of these advances has been the implementation of multidisciplinary Acute Pain Services in the hospital setting to take on accountability for acute pain management. Acute Pain Services are expanding rapidly in the Canadian health care system. Nurse administrators will be increasingly called upon to help with the establishment and evaluation of these programs. The purpose of this study was to examine the effectiveness of, and staff satisfaction with, one Canadian Acute Pain Service. Results of the study indicated that staff were generally satisfied with the Acute Pain Service and felt that the program had made a significant impact on the treatment of acute pain within the hospital; although improvements in pain outcomes were not noted. Adequate communication mechanisms and resources to allow for appropriate workload, education and clinical support are critical to the development and success of an Acute Pain Service.

Like other businesses in North America, the Canadian health care system is undergoing significant and widespread change. It is inevitable in these times that some organizations, some structures, some units will become irrelevant in their existing forms, and should be fundamentally altered, or discontinued altogether. The need for such decisions is too often resisted, denied or avoided. Voluntary organizations and associations are particularly vulnerable to the forces of change and transition. These organizations are as likely as any other to need reexamination, and perhaps even more likely to "miss the signals" heralding a need for redesign. There aren't many examples of voluntary groups which have either discontinued their operations, or radically changed their mandates; the Toronto Association for Quality in Health Care (TAQHC) is one such organization. It is the authors' hope that by sharing TAQHC's decision and process for dissolution we may be able to assist other organizations facing similar challenges. It is further our belief that many of the lessons learned from this experience are applicable to situations other than those of voluntary organizations.

Support from the work environment, attitude of nurses and availability of research findings are variables that influence the use of research in clinical practice. Acknowledging the importance of these variables in obtaining the goal of evidence based nursing practice, a nursing department of an acute care hospital determined that exploring these variables in its own setting was important to the successful planning of research education and utilization initiatives. This study describes the extent of selected factors (research support and availability, and attitude towards research) in relation to research utilization within this nursing department and based on the findings, suggests a number of ways nurse administrators can support research utilization, promote positive attitudes towards research and enhance availability of research findings in practice.

Influential health care leaders have recently said that it is a misnomer to refer to the current muddle of Canadian health care services and providers as a "system." Consequently, Canadian professionals and citizens have been exposed to increasing numbers of publications recommending that a move to fully and properly Integrated Delivery Systems (IDS) could rectify many of the difficulties with which our current non-system is faced. There is, however, a skepticism that the 'IDS movement' is just another in a series of fads that will come and go, without positively impacting the health care system. In this article, the authors provide arguments for why integration is critically required, an overview of types of integration, the qualities of a fully integrated system, and a discussion of the advantages and cautions to proceeding with IDS development. They conclude with the argument that--despite potential obstacles--the possible advantages of IDSs make it vital that we pursue integration.

While access to information resources and the skills to use them do not ensure that nurses will use nursing research in their practice, they are important facilitators. Mailed questionnaires to assess existing information resources, the information management skills of nurses, and what additional resources and training are required were returned by 67 of the 71 vice-presidents or directors of nursing in hospitals in two regions of Ontario. The two regions have similar information resources, nursing staff with research expertise, and opportunities for training in research and information management but there is variation among hospitals. Most vice-presidents agreed that nurses need better information resources and skills to access and evaluate professional literature. The rapidly developing field of information technology, including the Internet, provides potential for sharing resources and expertise. Nursing administrators can minimize barriers and help staff nurses recognize that information management skills enhance professional development and improve patient care.

Reconfiguration of health service delivery has raised questions and concerns about the category of provider qualified to administer and monitor medications on inpatient units. The competency base (i.e. the scope of knowledge, skills and judgements) required, is dependent on the health status of the patient population and the medications prescribed. As part of a larger study addressing nurse competencies (Alcock, 1995), the required knowledge, skills and clinical judgement related to medication administration and monitoring for patients on two long term care units in a long term care facility and two tertiary care units in a general teaching hospital were determined. The total number of medications prescribed across the four units varied from 120 to 256 medications per unit. The number of different drug classes ranged from 27 to 32 per unit and the potential for drug-drug interactions ranged from 47% to 66% of prescribed medications across the units. The findings provide an information base for decisions related to education and to staffing. Various nursing delivery system options and factors which influence competency are discussed.

The purpose of this article is to describe the process of undertaking a large scale nursing pain management initiative, that we entitled "Pain Month." Several educational resources and strategies were employed in an effort to increase nurse's knowledge on the subject of pain management. Pre and post patient satisfaction surveys were conducted to test the effect of the education on actual pain management. The results showed improvements in actual pain scores and in satisfaction with pain management; however, several more improvements were shown to be necessary to achieve excellent pain management for patients. Follow-up initiatives such as a pain resource nurse program, an interdisciplinary pain committee and continued, patient surveys have been implemented to address some of these existing issues.