Patient needs in the emergency department: nurses' and patients' perceptions.

Patients arrive at emergency departments in distress. Physical needs are addressed, but less pressing emotional and social needs often go unrecognized. Although patients may not articulate their concerns, they may later feel dissatisfaction if needs were unmet. This study determined whether emergency department patients and nurses have similar perceptions of patients' needs, and which needs patients identify as most important. A convenience sample of patients and nurses in a two-hospital system was selected. Study results indicate that nurses may not always perceive accurately patients' needs or the strength of those needs. Institutions that place a high value on patient satisfaction with care must treat patient-centeredness as a priority--at all institutional levels.

Creative discharge planning using the electronic medical record.

A multidisciplinary continuous quality improvement (CQI) team at the authors' facility was commissioned and empowered to study and improve communication among the disciplines involved in discharge planning. CQI methods and tools were applied to analyze the process and determine the improvement. The authors of this article describe the use of a customized electronic medical record system to deliver accurate, rapid technology (DART) at their facility. DART was programmed to improve communication among the disciplines by assisting with the referral process. In addition, users are systematically prompted throughout the discharge process to ensure that all aspects are considered and documented.

Innovations in human service technologies. Strengthening health care delivery systems.

The authors report on innovative approaches to the organization of health services and the delivery of patient care in 19 U.S. hospitals and hospital networks. Strengthening patient care is the focus of this initiative. Hospital-wide interdisciplinary planning and the subsequent trial of new human service technologies are explored.

Strengthening hospital nursing, Part III. Differences among professional groups in the hospital planning process.

Interdisciplinary hospital planning processes are examined. Nurses, physicians, hospital administrators, and support and ancillary personnel from 75 hospitals participating in the national Strengthening Hospital Nursing Program indicate their perceptions of the project in relation to the centrality of the program in their hospitals, planning team development, and political issues. Differences and similarities among the professional groups are discussed. Additional articles on the Strengthening Hospital Nursing Program have appeared in the May and June 1992 issues of JONA. Part 1 explored the planning process in single and consortium hospital sites, and Part 2 examined the characteristics of effective planning processes.

Strengthening hospital nursing, Part 2. Characteristics of effective planning processes.

Characteristics of the planning process for 213 hospitals participating in Phase 1 of the Strengthening Hospital Nursing Program (SHNP) are described. Differences in planning between the Phase 2 implementation sites and those sites not selected for continued funding are explored. Factors associated with positive planning outcomes among participating hospitals are delineated. The use of the SHNP planning process as a model for other hospitals is suggested. This article is Part 2 of a 3-part series on the planning process within the national Strengthening Hospital Nursing Program. Part 1, contrasting single and networked hospitals, appeared in the May issue of JONA. Part 3, which examines interdisciplinary differences, will appear in the July/August issue.

Strengthening hospital nursing. Part 1, The planning process.

Planning is identified as a key activity of hospital management. Planning processes are examined for 75 hospitals in the national Strengthening Hospital Nursing Program (SHNP). The nature of the planning process is presented with a focus on professional participation in planning, differences between single and networked hospitals, and the development of planning teams. The importance of certain elements for planning teams is considered. Part 2 (June 1992 issue) will examine the planning characteristics between Phase 2 selected and nonselected hospitals. Part 3 will explore the differences among professional disciplines in planning.

Organizational change toward a nursing agenda. A framework from the Strengthening Hospital Nursing Program.

Although nursing is central to most efforts aimed at changing U.S. hospitals and care delivery systems, little is known within the profession about initiating or participating in large system--total hospital--change. Using data from the national Strengthening Hospital Nursing Program, a program supported by the Robert Wood Johnson Foundation and The Pew Charitable Trusts, the authors explore what organizational factors are relevant for hospital change that is systemic, ambitious, and favorable to a nursing agenda.

Strengthening hospital nursing: innovations for the improvement of patient care.

Hospital services account for over 40% of the total U.S. expenditure on health care. A key to the provision of effective and efficient hospital services rests on an adequate number of qualified nursing staff. The demand for qualified nurses continues to outstrip the existing and anticipated supply. In addition, hospitals face a growing public accountability for quality patient care. To meet these challenges, hospitals must develop innovative strategies to strengthen hospital nursing and improve patient care. A major challenge to the industrial engineer/health systems engineer is how to best design the hospital system of the future. The purpose of this paper is to enumerate common problems experienced in hospitals and to describe the innovative solutions to these problems proposed by hospitals across the nation.

Clinic management teams: integrators of professional service and environmental change.

Clinic management teams comprising an administrative director, a head nurse, and a physician manager are interdisciplinary management units in an ambulatory care setting of a large teaching hospital. This article reviews the development of these integrative teams and the factors critical to their success.