Subject(s)
Community Networks/standards , Critical Pathways/organization & administration , Delivery of Health Care, Integrated/standards , Outcome Assessment, Health Care/organization & administration , Community Networks/organization & administration , Delivery of Health Care, Integrated/organization & administration , Documentation/standards , Hospitals, Community/organization & administration , Hospitals, Community/standards , Joint Commission on Accreditation of Healthcare Organizations , Medical Audit , Michigan , Planning Techniques , Total Quality ManagementABSTRACT
A 528-bed community teaching hospital redesigned its patient care delivery system, implementing a collaborative practice model on the 30-bed inpatient rehabilitation unit in April 1990. This model is a patient-centered delivery model that encourages the healthcare team to facilitate the achievement of patient outcomes within effective time frames and with an appropriate use of resources. The collaborative practice model includes a nurse case manager's role for the staff nurse, which had as its frame-work the concept of nursing case management. Tested project management techniques were used to ensure a successful implementation process. Various strategies, such as using project teams and providing educational programs, were used to respond to the issues of role conflict and overlap, especially between social workers and nurse case managers. The implementation of this model provided a number of benefits, including improved interdisciplinary relationships and decreased length of stay.
Subject(s)
Nursing Service, Hospital/organization & administration , Patient Care Planning , Patient Care Team/organization & administration , Rehabilitation/nursing , Humans , Interprofessional Relations , Length of Stay , Models, NursingABSTRACT
Cell death is a normal feature within the chick chorioallantoic membrane, occurring principally between days 10 and 14 of incubation. Samples of chorioallantoic membrane were obtained on days 6, 8, 10, 12 and 14 of incubation, after the creation of artificial air chambers on day 3. These were examined by scanning electron microscopy (SEM), transmission electron microscopy (TEM) after staining for acid phosphatase activity, and by light microscopy after demonstrating oxygen free radicals with nitro blue tetrazolium. On day 6, small defects in the plasmalemma, approximately 200 nm in diameter, could be seen by SEM. A sequence of events leading to complete destruction of the plasmalemma, with exposure of the nucleus and other cytoplasmic organelles, could be traced, and by day 8 the membrane was a mosaic of healthy cells and others in various stages of degeneration. TEM revealed that acid phosphatase activity was confined to the golgi apparatus and associated vesicles even in advanced stages of degeneration. By comparison, oxygen free radicals were demonstrated in individual cells from day 6 onwards. Application of superoxide dismutase and catalase to the epithelium using a nebuliser spray significantly reduced the amount of cell death seen by scanning microscopy on day 12. It is concluded that oxygen free radicals may mediate cell death in the chorioallantoic membrane.
