The development of advanced practice roles: implications in the international nursing community.

This article examined the critical elements that have been identified in the development of advanced practice roles of nurses in four countries: Brazil, Thailand, the United Kingdom and the United States of America. Several sociopolitical and professional forces were examined for possible insights and ways in which they may have shaped the development and evolution of the roles of advanced practice nurses (APNs). These forces were: the socio-political environment; the health needs of society; the health workforce supply and demand; governmental policy and support; intra- and interprofessional collaboration; the development of nursing education; and documentation of effectiveness of the advanced role. The development of APN roles in the four social systems was reviewed to illustrate how socio-political and professional forces may have shaped nursing roles in each health care delivery system. Commonalities and distinguishing features across the four health and social systems were analysed to assess the predictive forces that may be identified as advanced roles in nursing have evolved in the global community.

Organizational culture and work redesign: experiences in three organizations.

Lack of attention to the organization's culture can mean failure for its strategic initiatives. The authors present the results of three case studies of work redesign initiatives in which organizational culture, as measured by the Competing Values Framework, was assessed before and after project implementation. The organization with a balanced culture at baseline and higher "adhocracy" (developmental) values after implementation was more successful than the two organizations with dominant baseline market and hierarchy cultures. Recommendations for increasing desired values and decreasing undesired ones are provided.

Evaluation of the multifunctional worker role: a stakeholder analysis.

Health care organizations are rethinking how care is delivered because of incentives generated by managed care and a competitive marketplace. An evaluation of a work redesign project that involved the creation of redesigned unlicensed caregiver roles is described. The effect of model implementation on patients, multiple categories of caregivers, and physicians was measured using several different approaches to data collection. In this evaluation, caregivers perceived the institutional culture to be both market-driven and hierarchical. The work redesign, along with significant changes in unit configuration and leadership over the same period, significantly reduced job security and satisfaction with supervision. Quality indicators suggested short-term declines in quality during model implementation with higher levels of quality after implementation issues were resolved. Objective measurement of the outcomes of work redesign initiatives is imperative to assure appropriate adjustments and responses to caregiver concerns.

Effects of implementing patient-centered care models on nurse and non-nurse managers.

Evaluation of new patient care delivery models often focuses on their impact on the role of the staff nurse and the introduction of a variety of assistive personnel. This article examines the effects of patient-centered care models on the roles of nurse and non-nurse managers. Interviews with 26 managers approximately 6 months after models have been implemented reveal a number of issues and challenges faced by the managers during and after implementation. The data provide a number of new insights not previously reported in the literature.

Nursing science in the global community.

Knowledge development and research are generally embedded in cultural values and perspectives. This article examines the development of knowledge in nursing in a global context and addresses the degree to which Western values and the social environment in the United States shape nursing theory development. Three perspectives illustrate the influence of US values and contextual factors. Questions are raised about the relevance of knowledge to other cultural or national contexts. Recommendations are made for nursing inquiry that makes knowledge more applicable to the global community.

Unplanned pregnancies in a midwestern community.

Despite widespread birth control availability and increasing emphasis on sex education, a large proportion of childbearing continues to be unplanned. Using an anonymous questionnaire, unplanned pregnancies were studied in Cedar Rapids, Iowa. Of 1,002 women who completed questionnaires, 56 percent had had one or more unplanned pregnancies, and 44 percent of all pregnancies were found to be unplanned. This study confirms the findings of other studies which have shown a similar proportion of unplanned pregnancies. More unplanned pregnancies occur in the younger, lower socioeconomic population. Women generally consider their lives unchanged or improved because of these unplanned births. However, unhealthy aspects of some unplanned pregnancies include self-blame and negative feelings toward both the father and baby. Furthermore, a considerable number of young women lack adequate birth control knowledge, and they desire more family planning information from their physicians.

An examination of the relationships between physicians' clinical and hospital-utilization performance.

To examine the relationships between measures of attending physician teams' clinical and utilization performance, inpatient hospital audits were conducted in 22 Maryland and western Pennsylvania nonfederal short-term hospitals. A total of 6,980 medical records were abstracted from eight diagnostic categories using the Payne and JCAH PEP medical audit procedures. The results indicate weak statistical associations between the two medical care evaluation audits; between clinical performance and utilization performance, as measured by appropriateness of admissions and length of stay; and between three utilization measures. Based on these findings, it does not appear valid to use performance in one area to evaluate performance in the other in order to measure or evaluate and ultimately improve physicians; clinical or utilization performance.

Research policies and practices in family practice residencies.

A questionnaire survey of all US family practice residency programs was undertaken to gather information pertaining to the policies and practices of resident research projects. Eight-one percent of the programs responded. The majority of the programs which responded require or encourage research by their residents. Cross-tabulations of the data relate several characteristics of residency programs to their positions on resident research. University based or affiliated/administered programs, programs with fewer residents and larger faculties, and programs in the faculty are engaged in research tend to encourage or require research by residents although these findings are not consistent. Information is also presented pertaining to financing resident research, preparing residents for conducting research, and disseminating the results of residents' projects.