Rural magnet hospitals of excellence. Part 2.

Although almost half of the hospitals in the United States are rural and small, they often are not seen as leaders in innovation. However, many practices now being adopted by large hospitals have been used in rural hospitals for many years. To understand excellence in rural hospitals, the authors present a study of rural hospitals of excellence, using procedures from the 1982 Magnet Hospitals Study. Part 1 was reported in the January issue of JONA.

Rural magnet hospitals of excellence. Part 1.

Although almost half of the hospitals in the United States are rural and small, they are often not seen as leaders in innovation. However, many practices just now being adopted by large hospitals have been used in rural hospitals for many years. To understand excellence in rural hospitals, the authors present a study of rural hospitals of excellence, using procedures from the 1982 Magnet Hospitals Study. Part 2 will be published in the February issue.

Pilot study of the relationship between heart rate and ectopy and unrestricted vs restricted visiting hours in the coronary care unit.

OBJECTIVE: To determine the relationship between cardiac performance (as measured by heart rate and ectopy) and unrestricted vs restricted visiting hours in the coronary care unit. DESIGN: Patients were from two coronary care units. Group A had unrestricted visiting hours, and group B had restricted visiting hours. Heart rate and ectopy were measured three times both in patients with unrestricted visiting hours and in those with restricted visiting hours: (1) before visitors arrived, (2) 5 minutes after visitors arrived and (3) 1 to 5 minutes after the visitors left. A total of 25 visits were analyzed. FINDINGS: There were no significant differences in rates of premature ventricular contractions and premature atrial contractions between the two groups. Patients with unrestricted visiting hours had a significantly lower heart rate after visits than patients with restricted visits. CONCLUSION: Consideration should be given to development of unrestricted visiting policies that promote the continuing presence and natural support of the family and significant others for patients in coronary care units.

Obtaining services for HIV-positive patients.

Services needed for HIV-positive persons and the availability of these services were reported in the July/August 1990 issue of JONA. This article includes further information from the original study--an analysis of the factors in each reporting hospital and community that enabled or barred the development of services for HIV-positive persons. This information offers strategies to nurse executives for obtaining services in their own settings.

Impact of case management on hospital charges of PWAs in Georgia.

To determine the effects of case management in controlling hospital based costs for persons with AIDS (PWAs), a retrospective review of records of deceased PWAs was performed. The study compared diagnosis-to-death hospital charges for PWAs who received care under a care management model (n = 60) with PWAs receiving care within a non-case managed approach (n = 60). Hospital charges were adjusted for inflation. PWAs receiving care within the case managed model had significantly lower hospital-based changes than the non-case managed group. Additionally, PWAs in the case managed group lived significantly longer between HIV diagnosis and death, and lived longer between their first AIDS-related hospital admission and death.

Rural nurses join forces for AIDS care.

Rural hospitals and communities across the nation lack comprehensive services for AIDS patients. This study identified 15 vital services that are scarce in rural settings at a time when AIDS is showing a greater increase in rural than in urban areas. Analysis of responses from rural settings that have acquired services shows that they were obtained through collaboration between rural hospitals and their communities. The authors identify strategies of successful communities that illustrate how rural hospital and community nurses can work together to obtain comprehensive services in their communities for persons with AIDS.

Future trends in nursing practice and technology.

Rural hospitals will be affected by changes in nursing anticipated in the future. Welcome changes will be the maturity and life experiences new graduates will bring to the work setting, knowledge of computers, and a broadening database. New graduates will also know various methods of care delivery, including case management, and will be able to select the delivery system that best meets the needs of the patients and institution. They will be more autonomous and possess leadership and management skills. With their knowledge of community as well as institutional nursing, they will be able to draw upon the skills of both groups to bring the two areas of nursing into continuity of care for patients. A difficulty ahead for rural hospitals is recruitment of new graduates, the majority of whom will have established families and lives elsewhere. And the practice of developing their own employees for higher levels of nursing will be compounded by the doubling of time necessary to complete nursing programs in the future.

Services for persons with AIDS. Nurse executives report.

The increasing number of persons with AIDS (PWAs) requiring healthcare services is a challenge to the organization and delivery of healthcare in the United States. The extent of these services is unclear. In this article, nurse executives report what services for PWAs presently exist or are planned. Management implications and strategies for developing AIDS care are addressed.

Rural nurses. Part II, Surviving the nurse shortage.

Cost containment and the nurse shortage have impacted rural hospitals and their nursing staffs. This impact did not appreciably affect burnout levels among the rural nurses, but did evidence itself in the reports of the directors of nursing and their nurses. Cost containment brought with it layoffs of colleagues in the work setting who were neighbors or relatives. This occurred while the rural areas were already filled with the unemployed and underemployed. Unfamiliar recordkeeping increased two- and three-fold, and the 23-hour admit caused unequal work flow. Downsizing, elimination of some services and reports of rural hospital closings were threatening to the nurses, who were often the sole support of their families. The rural nurse shortage was seen to be different from the national nurse shortage in significant ways. Except for the few study hospitals that were close to population centers, nurses could not be recruited from outside the geographic area. Suggestions from the Secretary's Commission on Nursing are not all appropriate for the rural hospital nurse shortage. Rural hospitals changed in the face of cost containment, and nursing personnel also worked to contain costs. However the nurses have worked within cost and salary constraints for so long that they predict loyalty to their community hospitals can be coming to an end. The nurse shortage is being approached by minor alterations in staffing and mode of care delivery. Federal support is desperately needed by the rural hospitals to permit equitable salaries, and to support financial aid to permanent residents of the rural areas for entrance into or advancement in nursing education.(ABSTRACT TRUNCATED AT 250 WORDS)

Rural nurses. Part I, Surviving cost containment.

Rural nurses from 13 small hospitals share their work lives and concerns. Five years of cost-containment have left them undaunted, but they worry about the financial viability of their hospitals. Their unique brand of nurse shortage has added an additional load that appears surmountable only through financial means, which have also disappeared through cost-containment. This is the story of "frontier nurses" and their fight to maintain an American institution.

Inpatient nursing case management as a strategy for rural hospitals: a case study.

Increasingly, hospitals are facing the dual challenges of cost containment and a nursing shortage. These challenges are especially problematic for rural hospitals where nursing staff must be recruited and quality standards maintained within the financial limitations of lower DRG reimbursement rates when compared with urban centers. Therefore, it has become necessary for rural administrators to find new approaches to maximizing the utilization of available nursing staff. Experts have proposed that one solution to the nursing shortage is redesigning the work of RNs to more fully utilize the knowledge and skill of nurses. Nursing case management--a system in which the registered nurse (RN) assesses patient needs, develops a plan of care, procures and coordinates needed resources, and provides ongoing evaluation of care--is one strategy for redesigning nursing roles which offers potential financial benefits to hospitals. Through daily coordination and evaluation of patient care activities, nursing case managers can ensure cost effective allocation of organizational resources and facilitate early discharge planning. This article includes a case study of a rural hospital that introduced the nursing case management system, the hospital's steps of planning and implementation, and examples of forms associated with the system.