Heart-smart service.

Cardiology patients--direct and ED admits--go to Lancaster General Hospital's Cardiology Admissions Unit (CAU) to receive care until a bed is available in an inpatient unit. The CAU yields high patient volume, positive patient and staff feedback, decreased ED length of stay, prompt initiation of treatment protocols, and more effective discharge planning.

Attitudes toward nurse practitioners: influence of gender, age, ethnicity, education and income.

Survey research was undertaken to measure relationships between gender, age, ethnicity, education, income level, and an individual's attitude toward using a nurse practitioner (NP) for health care. Pender's Health Promotion Model provided the theoretical basis for the research initiative and instrument design. Following initial pilot work, 238 individuals were surveyed. While no significant differences on the basis of gender and race were found, high school graduates demonstrated significantly more positive attitudes toward NPs than non-high school graduates, and older subjects and those with lower incomes were less positively inclined to use NP services. These findings have implications for the marketing of NP services, NP education, and public education, and should be used as a basis for additional research in this area.

Continuing education as a facilitator of change: implementing a new nursing delivery model.

When a new approach to the delivery of health care services at GSH was developed, it was recognized that the staff nurses needed to be well informed and accepting of the importance of this new model and their impact on its success. The use of educational sessions to acquaint all staff, even those not directly affected initially, was essential. And, the use of a normative-reeducative approach to change implementation by administration built on the initial success of the continuing education program by providing multiple opportunities for collaboration and communication at all staff levels. This combination of the educational program with follow-up strategies addressed a number of recommendations in the research on the transfer of continuing education to nursing practice. The information gleaned by the use of the questionnaires to determine the knowledge level and attitudes of staff members on the Connection Delivery Model emphasized how critical their acceptance of this change was. By gaining staff nurse support and influence, it was possible to advance the program and assist patients through the provision of care across a continuum of services.

Using case management with clinical plans to improve patient outcomes.

A case-management approach using clinical plans was developed to enhance outcomes. Patients with congestive heart failure (CHF) who were admitted to home care and case managed by nurses specially trained in cardiovascular nursing, case management, and the use of a clinical plan, had improved outcomes with fewer visits than patients with CHF managed with traditional care practices. Quality management and cost-effectiveness of patient care may be positively affected when using this approach.

Care manager/nurse manager: a blending of roles.

Excellent clinicians often are "promoted" to management positions. Lack of involvement in patient care can lead to diminished nurse manager satisfaction, so job enrichment and enhancement must be as important as efficiency and economy as healthcare undergoes reform. A study of 314 patients from 20 DRG categories revealed a statistically significant shortened length of stay and a savings of at least $552 per care-managed patient. Satisfaction was widespread among nurses, patients and physicians and a collaborative spirit developed between nurses and physicians. The blended care manager/nurse manager role alleviates much frustration and conflict and enriches the performance of the manager.

A collaborative effort in using telecommunications to enhance learning.

A consortium of three educational institutions was developed to respond to a possible need for educational programs in the workplace through teleconferencing technology. Based on survey findings, a pilot project of three educational programs was presented. Evaluation of the adequacy of such programming indicated its success in the use of such technology. The effort was unique because there was unprecedented collaboration among nurse executives, nurse educators, the Pennsylvania Nurses Association, the Hospital Association of Pennsylvania, and WITF, the publicly owned telecommunications center.

Nursing intensity. Going beyond patient classification.

Two patient classification systems, Medicus and GRASP, were compared to the Patient Intensity for Nursing Index (PINI). Approximately 50% of the variability in both classification systems was not accounted for by PINI items. The patterns of correlation between PINI items and GRASP and Medicus scores indicated that these two classification systems do not measure nursing resource use in the same way. Nurse administrators should be aware that estimates of nursing care costs will vary depending on the patient classification system used to measure nursing intensity.

The Patient Intensity for Nursing Index: a validity assessment.

The psychometric assessment of a new measure of nursing intensity, The Patient Intensity for Nursing Index (PINI) is reported. Four dimensions of nursing intensity are measured by the PINI: (a) severity of illness, (b) dependency, (c) complexity of care, and (d) time. There are 10 items rated on a 5-point ordinal scale. A purposively drawn sample of 6,445 patients was obtained from five hospitals, with 487 registered nurses (RNs) providing daily patient ratings from 29 medical-surgical and intensive care units. Substantial interrater reliability was demonstrated. Validity testing included confirmatory factor analysis, hypothesis-testing, contrasted groups, and an observational study of time. The factor structure confirmed specified components of severity, dependency, and complexity, with time loading on all three factors. PINI scores were significantly related to medical severity of illness, length of hospital stay, disposition at discharge, number of secondary medical diagnoses and specialty consults, and scores on three different hospital classification systems used for staffing. PINI scores were significantly different for high- and low-intensity DRGs. Observed time spent delivering nursing care to specific patients was significantly correlated with nurse estimates of time.

Changing how nurses spend their time.

The results of work sampling studies are used to examine how nurses spend their time and to relate nurses' time to the shortage of nursing practice in hospitals. Four types of proposals for improving the delivery of nursing care in hospitals are discussed. The likely impact of these proposals on how nurses spend their time and the consequences of increasing the effectiveness of professional nursing practice are explored.

The process of rater training for observational instruments: implications for interrater reliability.

Although the process of rater training is important for establishing interrater reliability of observational instruments, there is little information available in current literature to guide the researcher. In this article, principles and procedures that can be used when rater performance is a critical element of reliability assessment are described. Three phases of the process of rater training are presented: (a) training raters to use the instrument; (b) evaluating rater performance at the end of training; and (c) determining the extent to which rater training is maintained during a reliability study. An example is presented to illustrate how these phases were incorporated in a study to examine the reliability of a measure of patient intensity called the Patient Intensity for Nursing Index (PINI).