Seminars for nurse managers最新文献

As an alternative to the administrative and management views of clinical integration, the perceptions and current research of patients and their families about integration initiatives are presented at "ground zero," i.e., the caregiving level. If there is no integration at ground zero, the other levels are of little merit. Contrary to the pervading opinion, clinical integration is not a value-added endeavor to boost satisfaction scores of patients and families or to make a health care system look good to regulators. Rather, clinical integration is fundamental to the precision, efficiency, and effectiveness of care delivery. Examples of the need for integration spanning situations from critical care to self-care are described.

The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from insurer to provider. The issues occasioned by market-based reform include: the problems presented by clashes between public expectations and payer restrictions; the corporatization of health service delivery and the cultural shift from humanitarian endeavor to business enterprise the depersonalization of treatment as time and money constraints stretch resources, and the culture rewards efficient "business-like" behavior the underfunding of care for the poor and uninsured, even as these populations grow the restructuring of care and reengineering of healthcare roles as the emphasis shifts from quality of care to conservation of resources rapid mergers of both health plans and institutional providers with all the inherent turmoil as rules change, services are eliminated, and support services are minimized to save money the unhealthy competition inherent in market-based reform that posits profit taking and market share as the measures of successful performance the undermining of the professional ethic of advocacy the use of incentives that pander to greed and self-interest. The costs of sophisticated technologies and the ongoing care of increasingly fragile patients have pulled many other elements into what previously were considered "privileged" professional interactions. The fact that very few citizens indeed could pay out-of-pocket for the treatment and ongoing care they might need led to social involvement (few people remember that both widespread health insurance and public programs are relatively recent phenomena--only about 30 years old). However, whether in tax dollars or insurance premiums, other people's money is being spent on the patient's care. Clearly, those "other people" never intended to give either the patient or the professional open-ended access to their collective pocketbooks. Just what form their involvement ought to take is being tested as "managed care" attempts to control the costs. What limits are acceptable to providers?: lower profit margins? quality controls? acceptable risk levels? To patients?: restricted choice? restricted mobility? restricted access to high tech? And to the general public?: decreased access to high tech? higher taxes? underserved populations? Abandonment of the sick or poor? Which "techniques" are acceptable, and which are not?: risk-sharing with providers? financial incentives for decision makers? rationing access? imposing behavioral parameters? The issues posed by market-based managed care cannot be adequately addressed merely in terms of social resources, nor will answers be found in subordinating human rights to practical materialism. Negotiating ethical guidelines for the "safe" handling of such problems to the good of individuals and of society requires a revitalization of the "old" values: the old commitment to master

Diversity among clients in the American health care system is increasing as the population of the United States changes in composition. Health providers, educators, and supervisors are in unique positions to enhance patient education among members of diverse cultures by incorporating cultural research and health beliefs into patient and staff education. Using a culturally defined framework, health providers can more holistically assess the client and subsequently plan culturally appropriate care.

Nursing is a profession founded on the traditional value of caring. Faced with rapid and tumultuous change in the health care system, nurses are finding the environment of practice more stressful and less supportive. The ideal of nursing as a caring community is at risk because of economic and political forces. The authors review the impact of managed care and reaffirm the notion of the caring community in the nursing profession. Specific assessment guidelines and recommendations for the caring community are set forth for practitioners working in a variety of organizational settings. Organizational culture is emphasized as the context for caring practice.

Because of the rapid growth of the non-English-speaking population in the United States, nurses are increasingly likely to be called on to provide care for patients whose first language is not English. As a result, nurse managers may need to make interpreters available to health care providers in a variety of settings to facilitate effective communication and provide quality care. The purpose of this article is to present nurse managers and nurse clinicians with information that will enable them to work effectively with interpreters.

The dramatic and rapid changes occurring in health care present many challenges and opportunities for nurse leaders as they deal with a culturally diverse society. Leadership style is an important consideration for a health care environment that promotes culturally appropriate care. This article presents a theoretical model that consists of management of change, principle-centered leadership, and transformational leadership, and describes how each of these concepts can assist in creating an environment that fosters culturally appropriate health care.