ABSTRACT
Accelerating clinical improvement is a unique strategic method for accelerating the rate and effectiveness of improvements in strategically important clinical services. It promotes real reduction in the cost of service while preserving the quality and value within the system. Based on the components of process, value, benchmarking, change, and learning, the method can be used in any system or setting to produce value-driven change. Accelerating clinical improvement is being used within the Obstetrical Department of Dartmouth-Hitchcock Medical Center to decrease postpartum length of stay for families with spontaneous vaginal delivery. Familiarity with the method led to additional and ongoing improvements in the system. This method is important for nurses because it is continuous, multidisciplinary, addresses values of concern to families and providers, and is easily incorporated by nurse providers in any clinical setting.
Subject(s)
Critical Pathways/organization & administration , Hospital Restructuring/organization & administration , Length of Stay , Obstetrics and Gynecology Department, Hospital/organization & administration , Outcome and Process Assessment, Health Care/organization & administration , Postnatal Care/organization & administration , Academic Medical Centers , Humans , Maternal-Child Nursing , New Hampshire , Organizational InnovationABSTRACT
1. A descriptive design was used to measure nurses' assessment of the prevalence of patients who are confused, the interventions used, and these patients' outcomes on three nursing units in an acute care setting. 2. Confused patients had less favorable outcomes at discharge than did the group of nonconfused patients. 3. Of the three interventions that were monitored, confused patients were more likely to have either restraints or medications than to have a sitter (a sitter was either a paid staff member or a family member who monitored the patient directly).
Subject(s)
Confusion , Acute Disease , Adolescent , Adult , Child , Confusion/epidemiology , Confusion/nursing , Cross-Sectional Studies , Female , Health Facility Environment , Hospitals, Rural , Humans , Middle Aged , Nursing Assessment , PrevalenceABSTRACT
This survey identified a range of adolescent pregnancy prevention activities used by school nurses in selected Mid-Atlantic public schools. A purposive sample of 224 public school nurses completed the School Nurse Questionnaire adapted from an instrument used previously to survey school nurses. Based on a 54% response rate, a task analysis revealed that respondents performed only one pregnancy prevention activity frequently. A sub-sample of nurses, serving students in grades 6-12, used seven of 21 pregnancy prevention activities frequently. Though nurses did not actually perform the remaining activities, they felt prepared to do so. However, the structure of school nursing services often does not allow adequate time or opportunity to engage in adolescent pregnancy prevention activities.
PIP: Public school nurses were surveyed in May, 1989 in a Mid Atlantic state to ascertain the nature of school nurse activities in adolescent pregnancy prevention. The sample consisted of 246 returned questionnaires out of 446 verified as having received it from a mailing to 600. The instrument consisted of a questionnaire developed by White to identify clusters of school activities which was expanded to include the following pregnancy prevention strategies: a facilitation cluster such as referral for pregnancy testing or contraception, or counseling for sex related problems; an instruction cluster such as directing assertiveness training, or teaching a family life/human sexuality education course; and an administration cluster such as coordinating activities for sexuality education, or participating in media campaigns for teen pregnancy prevention. Activities were rated on how frequently these activities were performed. The nurse respondent profile was one of primarily female, middle aged married mothers. 77.1% served elementary schools (K-5th) and 44% in middle schools (6-8th). 35% had a high school population (9-12th). Nurses worked in multiple settings and 55% served 500-5000 students/nurse, and another 32.1% served 499 students/nurse. The results indicated that only 1 strategy, "communicating with teachers regarding a student's performance", was used frequently (weekly to 1-2 times as month), but nurses felt well prepared in handling this facilitative function. 25-45% reported using 7 other pregnancy prevention strategies weekly to monthly. These activities were referring for pregnancy counseling, referring for pregnancy testing, counseling students individually for sex related problems, communicating with teachers regarding a student's performance, referring for contraception, counseling for suspected pregnancy and referring students with behavior problems to community resources. Nurses felt moderately to extremely well prepared to handle these functions. 20% of respondents felt that 5 of the activities should be handled by someone else. The 14 remaining activities were rarely or never performed by nurses, and 20-35% felt these activities should be performed by someone else. In the separate analysis of nurses serving 6-12th grades, the same 7 prevention strategies were the most frequently performed. Nurses perceived all activities to be appropriate functions. School board policies or influence limited functions; time was another factor. The implications are that nurses may need to increase their use of primary prevention activities in 6-12th, and nurses in K-5th need to understand the importance of instruction in human sexuality and human relations for younger students. Nurses are not being used to their full capabilities, but political and economic issues also need resolution. Nurses must assume a more activist role.
