ABSTRACT
This article describes the use of action research as an information base for policy formulation by a collaborative partnership in Spokane, Washington. Health and social service providers recognized access to care by uninsured persons as a major community issue. Little was known from the consumers' perspective about factors limiting access. No benchmarks existed against which to measure progress. Investigators collected mailed surveys from 475 residents of six Spokane neighborhoods and 97 persons participated in 12 focus group sessions. Income, education, and ethnicity were primary factors affecting perceptions of degree to which medical, dental, and mental health needs were being met. Many residents were unable to obtain needed health care; low-cost dental and mental health services were named as their highest priorities. Quality of care, relationships with providers, immediacy of access, and cost were important concerns. Major barriers were cost, length of time before one could get an appointment, lack of comfort with providers, and having to miss work for appointments. Consumer input is critical in understanding local issues in health care. Action research that combines qualitative and quantitative data enhanced practice/policy decisions through assuring ownership of the research and immediate use of findings by involved agencies.
Subject(s)
Consumer Behavior , Health Care Surveys/methods , Health Services Accessibility , Focus Groups , Health Care Costs , Policy Making , Quality of Health Care , WashingtonABSTRACT
What exactly is it that makes someone a parent? Many people hold that parenthood is grounded, in the first instance, in the natural derivation of one person's genetic constitution from the genetic constitution of others. We refer to this view as "Geneticism". In Part I we distinguish three forms of geneticism on the basis of whether they hold that direct genetic derivation is sufficient, necessary, or both sufficient and necessary, for parenthood. (Call these 'Sufficiency', 'Necessity', and 'Strong' Geneticism, respectively.) Part I also explores the relationship between geneticism and the debate over surrogacy. Parts two through four examine three arguments for geneticism: the Property argument, the Causal argument, and the Parity argument. We conclude that none of these arguments succeeds. The failure of positive arguments for a view cannot demonstrate that the view is false; however, in light of our arguments we provisionally conclude that 'Strong' and 'Necessity' Geneticism are unacceptable. Our arguments do not undermine 'Sufficiency' Geneticism, so this thesis is considerably more promising than the others. But sufficiency geneticism is also compatible with a much more pluralistic account of the nature of parenthood.
Subject(s)
Parent-Child Relations , Parents/psychology , Pedigree , Surrogate Mothers , Adult , Child , Fathers , Female , Humans , Mothers , Reproductive Techniques, Assisted , Surrogate Mothers/psychologyABSTRACT
Medication calculation errors occur in all settings and can cause serious disruption in treatment protocols. This experimental study used a pretest-posttest, control group design. Sixty-seven RNs from three healthcare agencies completed all phases of the study. All nurses completed a 20-item medication calculation test, used both as the pretest and the posttest, and completed a short questionnaire that contained demographic and attitudinal items. After taking the pretest, nurses were assigned randomly to one of three experimental groups or a control group. Intervention times for the experimental groups totaled 3 hours, followed by a posttest 4 to 5 months after the pretest. Scores on the pretest ranged from 25% to 100% (mean = 75.5%, standard deviation = 15.13) and from 30% to 100% on the posttest (mean = 80%, standard deviation = 14.72). Scores improved for all groups except the self-study workbook group. No significant difference was found between the experimental groups or the control group for posttest medication calculation test scores. The classroom intervention was most costly, and the workbook intervention was least costly. The nurses identified the workbook intervention as the most satisfying method and computer-assisted instruction (CAI) as least satisfying. A strong positive correlation existed between the nurses' self-assessment of comfort and skill levels with medication calculation test scores. Questions necessitating multiple calculations and those necessitating a conversion not provided were the most difficult to answer correctly. Staff development educators need to address their role in improving the effectiveness of medication calculation.
Subject(s)
Computer-Assisted Instruction/standards , Drug Therapy/nursing , Education, Nursing, Continuing/methods , Mathematics , Medication Errors , Nursing Staff/education , Programmed Instructions as Topic/standards , Clinical Competence , HumansABSTRACT
Theoretical and experiential learning in community assessment are essential components of the preparation of first-level community health nurses. This article describes a collaborative community practice project in which faculty incorporated senior baccalaureate community health nursing students as participants. Students assessed availability and utilization patterns of health care services in Spokane, Washington. Data derived from the survey were used by community planners in addressing issues of access to health care by low-income persons. Learning outcomes of this experiential process are described within the context of Burnard's Experiential Learning Model and community health nursing course objectives. Recommendations for design of similar experiential learning opportunities are made.
Subject(s)
Clinical Competence , Community Health Nursing/education , Community Health Services/organization & administration , Education, Nursing, Baccalaureate/organization & administration , Interinstitutional Relations , Health Services Accessibility , Humans , Learning , Models, Educational , Models, Nursing , Poverty , Students, Nursing/psychologyABSTRACT
Lack of access to health care is a concern in many communities. A group of representatives from health, social service, other community agencies and nursing education meet regularly to address issues in providing care to homeless, low-income, and uninsured persons in Spokane, Washington. This group's efforts has been hampered by lack of clearly identified factors that adversely affect access to care. One aspect of community analysis performed by this group used a collaborative community practice model. Community diagnoses were determined from information collected from service providers. Community health nursing faculty, as clinical specialists, can play a role in such a collaborative process.
Subject(s)
Community Health Nursing/organization & administration , Community Participation , Health Services Accessibility/standards , Ill-Housed Persons , Interinstitutional Relations , Medically Uninsured , Poverty , Health Planning , Health Policy , Health Status Indicators , HumansABSTRACT
Codependence is a progressive emotional and behavioral disease that makes life painful. Because of nursing's historical roots and the present role of advance-practice nurses in the health care system, nurse practitioners are at risk for developing this disease. Codependence interferes with nurse practitioner's job performance by causing dysfunctional interactions with supervisors, peers and subordinates. A personal program of recovery is the only way to halt the progress of this syndrome and to re-establish healthy work patterns. The stages of recovery from codependence are identification, awareness, reintegration and genesis. Tools of recovery include involvement in a 12 Step program, connecting with other recovering people, daily affirmations and meditations, and attending programs and workshops on codependence.
Subject(s)
Nurse Practitioners/psychology , Stress, Psychological/psychology , Compulsive Behavior , Humans , Identification, Psychological , Mood Disorders/psychology , Self Concept , Social Behavior Disorders/psychology , WorkloadABSTRACT
A convenience sample of 110 registered nurses in four western states completed a demographic questionnaire and a 20-item medication calculation test to investigate errors in medication calculation that contribute to medication error rates. Intravenous questions were most difficult, then oral, then intramuscular/subcutaneous items. Nurses erred more when more than one calculation was required and when milligram to grain conversion was needed. Nurses who rated their skill and comfort with medication calculation above average scored higher. Yet 81 percent of the nurses were unable to correctly calculate medications 90 percent of the time and 43.6 percent of the test scores were below 70 percent accuracy. Strategies are suggested which may be used in staff development in identify registered nurse medication calculation abilities and to enhance these skills in practicing nurses.
Subject(s)
Dosage Forms , Drug Therapy , Nurses , Clinical Competence , Humans , Medication Errors , Nursing Education ResearchABSTRACT
Since 1979, over 700 junior level baccalaureate nursing students at the Intercollegiate Center for Nursing Education (ICNE) in Spokane, Washington, have had their basic mathematical skills tested, using a teacher constructed examination. The "Mathematics Proficiency Exam" utilized evaluates the nursing student's ability to add, subtract, multiply, and divide whole numbers, fractions, decimals, and percentages. Ratios, proportions, and problems are also included in the exam. The results of the testing have been surprising. From 9% to 38% of each student group tested have been unable to pass all parts of the examination at the 70% level. These findings have led the ICNE to require basic mathematical proficiency via the "Mathematics Proficiency Exam," developed by the authors, as a criterion for admission to the upper division nursing major. Subsequently, competence in medication calculation skills has been required within the first clinical course at the ICNE via a second teacher-constructed examination.
