Nurse anesthesia students with disabilities: a legal and academic review of potential professional standards.

Establishing suitable and proper program admission criteria that protect both the rights of disabled applicants and professional needs to educate competent practitioners concern every nurse anesthesia educational program. Disabled Americans must be legally protected while ensuring that future nurse anesthetists meet expectations for professional competency To balance these demands, academic programs must establish criteria that define qualifying standards for practice. Such criteria serve the important function of providing notice to prospective applicants, as well as to established practitioners, about minimum professional competencies and behaviors. This paper, based on a presentation, "Special Needs Students--an Attorney's Perspective," to program faculty of the American Association of Nurse Anesthetists in Ft Lauderdale, Fla, in February 2005, posits specific language to aid in defining admission criteria that are both inclusive and exclusionary. It seeks to stimulate debate about developing some professional consensus on a matter of continuing importance.

Hospital readmission from home health care before and after prospective payment.

PURPOSE: To describe and compare clients who were readmitted to the hospital during an episode of home health care, before and after the inception of the prospective payment system (PPS). DESIGN: A longitudinal mixed design was used to replicate a study conducted 9 years previously (pre-PPS) in the same home care agency in the central part of the United States. METHODS: Seventy-six closed-case medical records from a not-for-profit hospital-affiliated home care agency were retrospectively reviewed and compared to pre-PPS data. The same data collection tool, the Hospital Readmission Inventory, was used for both pre- and post-PPS studies. Nurse administrators at the data collection agency were interviewed concerning comparative results. FINDINGS: Currently readmitted clients were sicker than were those in the previous research report, they were readmitted sooner for a different diagnosis, and they had less continuity of services. CONCLUSIONS: The home health care industry has undergone a dramatic change in payment for services, from fee-for-service to PPS. Of particular concern is the adverse patient outcome of an unplanned hospital readmission. Prior studies have characterized such patients in home health care, but no comparative reports were found in a literature search since the inception of PPS. Findings from this study indicated that an increased emphasis on cost containment and higher-risk clients appear to have changed patterns of care delivery.

Hospital readmission from a transitional care unit.

The purpose of this project was to characterize patients readmitted to the hospital during a stay in a transitional care unit (TCUT). Typically, readmitted patients were females, widowed, with 8 medical diagnoses, and taking 12 different medications. Readmission from the TCU occurred within 7 days as a result of a newly developed problem. Most patients did not return home after readmission from the TCU. Understanding high-risk patients' characteristics that lead to costly hospital readmission during a stay in the TCU can assist clinicians and healthcare providers to plan and implement timely and effective interventions, and help facility personnel in fiscal and resource management issues.

Realigning the communication paradigm in nursing case management.

Communication underlies all of case management (CM), and better comprehension of the processes of communication within the context of the CM role may facilitate positive patient and organizational outcomes, and assist providers and policy makers in designing effective CM systems. Thus, the purpose of this qualitative, pilot project was to explore dimensions of communication of the nurse case manager role within a hospital setting. The results describe a "hub and spoke" model of communications and suggest the utility of this familiar model for understanding the communication dynamics for those who work as nursing case managers in hospital settings. Findings suggest that nurse case managers are at various times both advocates and mediators--communications roles that may encompass somewhat contradictory demands and perspectives.