Reducing turnover and improving health care in nursing homes: the potential effects of self-managed work teams.

This article describes the use of self-managed work teams (SMWTs) in a nursing home, their potential impacts on the provision of health care and employee satisfaction and turnover, and the factors reported to be important to SMWT effectiveness. Three SMWTs in a midsized nursing home in Wisconsin provide examples. Steps for implementing SMWTs are described.

Assisted suicide: factors affecting public attitudes.

Public support for assisted suicide has been growing despite the ethical questions raised by members of the medical profession. Previous research suggests that age, gender, experience, and religiosity are factors affecting individuals' attitudes. This study examines the effect of demographic and ideological factors, as well as individuals' caregiving experiences, on attitudes toward assisted suicide. Random-digit-dialing procedures produced a sample of 156 residents of Denton, Texas, in March 1998. T-tests were conducted to measure significance, while gamma values were used to measure level of association and percent reduction in error. The data indicate that age, gender, and caregiving experience were not significant predictors of attitudes. Situational factors, including whether a physician or friend/family member should assist and whether a child or a terminally ill patient experiencing no pain should receive assistance, all were highly significant and positively associated with attitudes toward assisted suicide. Respondents were most likely to support physician-assisted suicide for individuals experiencing no pain. The data also indicated that the depth of commitment to the beliefs that suffering has meaning, that life belongs to God, and that physician-assisted suicide is murder, were highly significant and negatively associated with attitudes toward assisted suicide.

Dental and medical considerations of patients with renal disease.

Often a dentist will have a patient with a complicated medical condition that needs to be considered when providing treatment. Following is an in-depth discussion of the medical and dental considerations of patients with renal disease.

Self-managed work teams: what works?

Case studies have shown that under the right circumstances, employees within self-managed work teams (SMWTs) produce more at work than employees organized in a more hierarchical, traditional structure because they perform not only technical skills, but management skills as well. The purpose of this article is to clarify the specific factors most important to an SMWT's success. The information shared here comes from three sources. The primary source is a research project funded by a 3-year grant (1994-1997) from the National Science Foundation. The primary factors found to affect the success of SMWTs formed five groups. Work process factors include those that are needed when actually performing the work, such as the appropriate resources, talent, procedures, and effort. Interpersonal process factors include communication and both positive and negative conflict. Environmental factors include those within the SMWT'S organization, such as management support and the reward system, as well as factors outside the organization, such as suppliers and the market. Team design factors and team member characteristics were found to be equally important to the high performance of the SMWT.

Employee age and perceptions of work in self-managing and traditional work groups.

Self-managing work groups are a form of work design in which employees take responsibility for the group's tasks and have discretion over decisions which impact group performance. To explore the impact of age and work teams on job attitudes, data from 477 employees suggested that self-managed work group members differed from traditional job holders regarding perceived general job satisfaction, perceived control by supervisors, as well as a number of specific dimensions of the work environment. Moreover, while there was evidence of an age effect on attitudes toward supervisory control, there was no joint effect of age by work design on job attitudes, i.e., one's perceived general job satisfaction. Older employees who were members of self-managed work groups were however, more impacted by this form of work design in reporting more positive perceptions of their access to information essential to the performance of their work. These findings suggest that an "older" work force should not be considered a barrier to implementing a work teams approach to job design.

Fevers in children.

Fever is one common reason that families seek medical or dental attention for a child. The fever reaction is a series of cellular events that begins peripherally and ends centrally with a resetting of the body's temperature set-point. The conditions that lead to the febrile reaction are many and include several oral etiologies. The health professional who initially evaluates the febrile child must use care in determining the cause, the severity, and the management of the patient's condition. In performing this task, one must consider the age of the child, the history of the illness, and the physical appearance of the patient.

Service use among low-income minority elderly: strategies for overcoming barriers.

The 1987 amendments to the Older Americans Act mandate a special effort to serve low-income minority elderly persons. A literature review showed that "practice-oriented" research on service use has focused primarily on identifying barriers with much less attention to identification of strategies for overcoming the barriers. This paper identifies and describes strategies used throughout Texas. Strategies addressing the "lack of knowledge" barrier included use of influential groups, working with significant individuals, and the media. Strategies addressing the "lack of access" barrier included transportation, affordability, and availability. Strategies addressing the "lack of intent" barrier focused on cultural differences, making services attractive, and overcoming negative attitudes toward service use.

Common oral mucosal lesions in adults.

Patients often present to family physicians with oral lesions. According to a recent study, the 10 most common oral mucosal lesions comprise almost three-quarters of oral lesions. The most common oral lesions are leukoplakia, tori, inflammatory lesions, fibromas, Fordyce's granules, hemangiomas, ulcers, papillomas, epuli and varicosities.

Financing geriatric programs in community health centers.

There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization.

Distance versus destination: stream selectivity of elderly interstate migrants.

Migration streams of persons age 60 years and older that share a common origin state, but with widely separated county-group destinations, were examined to determine the relative effect of distance upon migration selectivity. Socioeconomic and demographic characteristics common to selectivity studies were used for the comparisons. The findings showed that distance made little difference. Controlling for destination, we matched and compared the characteristics of older migrants from states of different distances. We looked at those coming to Arizona from California, Illinois, and Ohio, to the New York City suburbs from Pennsylvania and Florida, and to Chicago from Michigan and California. Repeatedly the story was the same. Distance was not an important factor; significant differences between these streams were rare. This analysis used the 1-in-100 1970 census public use microdata sample and used tests for identifying significant differences between streams.