ABSTRACT
Preliminary data developed by the Health Care Financing Administration under its pilot cooperative cardiovascular screening project indicate that 50 percent of Medicare heart attack patients arriving in emergency departments who are appropriate for thrombolytic therapy do not receive it within the time period specified by the American College of Cardiology. Indicators developed for quality assurance monitoring and evaluation of a hospital emergency department prompted closer review of some cases. It was determined that a critical outcomes team using the principles of total quality management and the FOCUS-PDCA models should be empowered to deal with these issues. Through this process, the need for the development of a chest pain center at the hospital was identified and supported.
Subject(s)
Chest Pain/diagnosis , Emergency Service, Hospital/standards , Total Quality Management/organization & administration , Algorithms , Chest Pain/therapy , Critical Pathways , Forms and Records Control , Humans , Institutional Management Teams , Management Quality Circles , Missouri , Outcome and Process Assessment, Health Care/organization & administration , Pilot Projects , Thrombolytic Therapy , United StatesABSTRACT
Although nurses may have the necessary skills to plan care of clients in a variety of settings, experience and research demonstrate that nursing interventions with women victims of violence have been consistently inadequate. Of the 243 nursing students included in this study, 8% reported experiencing physical abuse, and 18.9% reported experiencing nonphysical abuse. Difficulties with depression for 26.1% of the students and some level of clinical stress were reported in over half of the group. Specific needs to combat violence and abuse against nurses and nursing students include providing better information on such behavior by incorporating family-violence education into nursing-school curricula, and using this proactively in confronting domestic violence in home and work settings.
Subject(s)
Spouse Abuse/statistics & numerical data , Students, Nursing/statistics & numerical data , Adolescent , Adult , Cross-Sectional Studies , Educational Status , Female , Humans , Incidence , Missouri/epidemiology , Personality Inventory , Socioeconomic Factors , Spouse Abuse/prevention & control , Spouse Abuse/psychology , Students, Nursing/psychology , Violence/prevention & controlABSTRACT
Nursing documentation in any area is essential, but in the patient with severe trauma and vascular injury it may be critical in evaluating change. In vascular trauma the nursing assessment and documentation provides a baseline for comparison of pulses in the emergency department, the intensive care unit, and the general or vascular floor. A retrospective review of vascular trauma charts performed at St. John's Mercy Medical Center in St. Louis, Missouri, revealed serious documentation omissions. In view of this study a new flow sheet for documentation was proposed, inservices were given, and a follow-up study is proposed for 2 years for implementation date. This study underscores the need to assess current documentation in every institution and regular review of records.
