ABSTRACT
Efficiencies are needed to speed the dissertation process and graduation of prospective new faculty. We used a workflow process, the PERT chart, to organize and manage the many time-delimited tasks necessary for a complex dissertation. This article presents a case example that describes our experience and timely completion of the dissertation. PERT charts are useful tools to improve efficiency in nursing education.
Subject(s)
Academic Dissertations as Topic , Data Display , Education, Nursing, Graduate/methods , Nursing Research/methods , Research Design , Efficiency , HumansABSTRACT
While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed.
Subject(s)
Nurses , Organizational Culture , Primary Health Care/methods , Primary Health Care/standards , Quality Improvement , Health Services Accessibility , Humans , Medically Underserved Area , Organizational Case Studies , Organizational Innovation , South CarolinaABSTRACT
PURPOSE: The purpose of this study was to explore the factors associated with hospital utilization among infants and young children with complex chronic conditions (CCC). DESIGN AND METHODS: A descriptive, retrospective study was conducted with 216 medical records of children with CCC. RESULTS: Greater complexity, younger age, living with siblings, use of public insurance or self-pay, use of more than one type of insurance, and presence of conditions affecting certain body systems were associated with increased hospital and emergency department (ED) utilization. PRACTICE IMPLICATIONS: Nurses must have a heightened awareness of these at-risk characteristics to prevent avoidable hospital admissions and ED visits.
Subject(s)
Chronic Disease/nursing , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Patient Admission/statistics & numerical data , Age Factors , Child, Preschool , Female , Hospitals, Community/statistics & numerical data , Humans , Infant , Male , Retrospective Studies , Risk Factors , Rural Population , Socioeconomic Factors , South Carolina , Trauma Centers/statistics & numerical data , Urban PopulationABSTRACT
Children with complex chronic conditions (CCC) have greater health care needs and use rates than children in general. Elevated health care use includes more frequent hospital admissions, longer hospital stays, and greater health care expenses. Prior studies have examined population characteristics associated with increased hospital admissions, emergency department (ED) use, and general healthcare use, yet few studies have investigated these events from the parents' or health care providers' point of view. The purpose of this study was to explore parents/caregivers' and health care providers' perceptions of the factors placing infants and young children with CCC at risk for or protecting them against hospital admissions and ED visits. Parents or primary caregivers participated in interviews, and health care providers in pediatric acute care, pediatric primary care, and emergency care participated in focus groups. Interview and focus group data were analyzed using directed content analysis and an ecological risk and protective factors model. The analysis revealed that parents/caregivers and health care providers described risk factors and protective factors on multiple ecological levels surrounding the child with CCC. This article presents these findings, which add to current knowledge of factors influencing hospital admissions and ED visits and may be used to inform interventions addressing high health care utilization in this population. This article concludes with the implications of the findings for future research and nursing practice.
Subject(s)
Caregivers , Chronic Disease , Emergency Service, Hospital , Health Personnel , Parents , Patient Admission , Child , Child, Preschool , Female , Focus Groups , Humans , Infant , Male , Qualitative ResearchABSTRACT
Children with medical complexity (CMC) have chronic conditions, intense healthcare needs, and high healthcare utilization. Proposed changes in the healthcare environment initiated by the Affordable Care Act have led to efforts toward preventing hospital readmissions. The purpose of this integrative review is to explore the current empirical literature and examine how hospital readmissions and repeat emergency department visits have been studied among CMC. A computer database search and ancestry search were conducted, resulting in a sample of 26 studies. The results of the integrative review are presented along with gaps in the literature and implications for nursing practice and research.
