The outpatient care of the heart failure (HF) patient is fragmented due to the lack of evidence-based practice guidelines use. The primary goal of this project was to improve the care of the HF patient in the outpatient arena through use of clinical pathways using the logic model as the project framework. The intervention was carried out over a 4-week period on a convenience, random sample of patients (n = 80) attending a cardiology practice. The patients were recruited from 2 physicians' patient populations and were selected based on an adult diagnosis of HF, reduced ejection fraction of <40% at some point in time, and the New York Heart Association (NYHA) functional class II-V. Comparisons were made in the documentation of care between patients on or off the pathway. The intervention included documentation of patient education, care follow-up, medications, NYHA functional class, and symptom exacerbation, documented in the electronic medical record. The quality of care data were evaluated based on 3 of the Joint Commission core measures for outpatient care of the HF patient. Additional data were collected regarding use of the clinical pathway based on provider and week of implementation. Data were analyzed via a Chi-square test of independence comparing pathway use by provider and use of pathway as study progressed. The comparative results show statistically significant differences in use of the pathway by provider and a statistically significant increase in use during the project . The quality of care results varied in statistical significance. The pathway utilization increased over time and provided a method for standardizing documentation of care for the HF patient in this outpatient clinic, a benefit for HF patients and providers in this cardiology practice and beyond.

There is a dearth of studies investigating methods by which parental compliance may be enhanced. The primary purpose of this study was to investigate the relative efficacy of four conditions--high information, prompting, incentive , and comparison control--in increasing parental compliance. The self-help recommendation was to obtain a book or video from a local library. Parents were from a small, rural, northern Utah community; their children were diagnosed with externalizing behavior problems. Chi-square analyses were utilized to assess statistically significant differences, and effect sizes were computed to assess magnitude of association. The incentive intervention influenced parental compliance to a greater degree than either the comparison control or other intervention conditions. A secondary purpose of the study was to investigate the association of certain sociodemographic variables with parental compliance. Results of a logistic regression were indicative of no contribution of sociodemographic variables to the prediction of parental compliance. The relationship of current results with previous studies is discussed, as well as implications for clinical practice and future research.

Introduktion: Att någon gång drabbas av psykisk ohälsa blir allt vanligare, därför är betydelsen av forskning inom området stor. Sjuksköterskor med sin specifika omvårdnadskompetens utgör den största personalgruppen inom psykiatrisk öppenvård men sjuksköterskans roll inom psykiatrisk öppenvård är begränsat beskriven i vetenskaplig litteratur. Detta innefattar aspekter kring sjuksköterskans egen roll samt i relation till andra yrkesgrupper inom psykiatrisk öppenvård. Syfte: Att beskriva sjuksköterskans upplevelse av sin egen roll inom psykiatrisk öppenvård samt upplevelsen av interaktionen med andra yrkesgrupper i sitt arbete. Metod: Studien var en deskriptiv intervjustudie med kvalitativ ansats. Sju sjuksköterskor arbetandes i psykiatrisk öppenvård inkluderades i studien. Data insamlades genom semistrukturerade intervjuer och analyserades sedan med kvalitativ innehållsanalys. Resultat: Sammanlagt skapades 25 kategorier: positiva respektive negativa aspekter i arbetet som sjuksköterska inom öppenpsykiatri, samarbete mellan de olika yrkeskategorierna i teamet, bemötande och uppskattning för sjuksköterskans kompetens samt sjuksköterskans bidragande kompetens i vården av patienten. Slutsats: Sjuksköterskans upplevelse inom psykiatrisk öppenvård är komplex och visar bland annat på känslor av hög arbetsbelastning, en odefinierad roll i interprofessionellt samarbete samt både undervärdering och uppskattning för sin kompetens. Uttryck för ett bidragande omvårdnadsperspektiv samt en bredare syn på patienten i vården visar dock på tydliga uppfattningar om sin kompetens som sjuksköterska. Allt detta är relaterat till flera faktorer såsom organisation, arbetskollegor samt den egna uppfattningen om sin yrkesroll i arbetet. / Introduction: At some point suffer from mental illness is becoming more common, therefore, research in the field is of great importance. Nurses with their specific nursing skills form the largest staff group in psychiatric outpatient care, but the nurse's role in psychiatric outpatient care is limited as described in scientific literature. This includes aspects of the nurse's own role and in relation to other professions in psychiatric outpatient care. Aim: To describe the nurse's perception of their role in psychiatric outpatient care, and the experience of interaction with other professionals in their work. Method: The study was a qualitative, descriptive interview study. Seven nurses working in psychiatric outpatient care were enrolled in the study. Data were collected through semi-structured interviews and analyzed with qualitative content analysis. Results: A total of 25 categories concerning positive and negative aspects of work as a nurse in outpatient psychiatric care, collaboration between the professions in the team, treatment and appreciation to the nurse's competence and nurses contributory expertise in caring of the patient were created. Conclusion: Nurse's experiences in psychiatric outpatient care are complex and show feelings of heavy workload, an undefined role in inter-professional collaboration and both under-valuation and appreciation of their skills. Though, expression of a contributory caring perspective and a broader view of the patient show views oft the nurse's competence. All this can be related to several factors such as organization, work colleagues and their own perception of their professional role in their work.

ABSTRACT Under the dramatic competition of all kinds of hospital and the raising of consumer awareness, it is becoming important issues for a hospital manager to improve the service quality of health care, further to enhance patient¡¦s satisfaction & loyalty. Many articles & papers discuss the outpatient service quality and patient¡¦s satisfaction with many single items of service process. In fact, the outpatient service is composed of a series of service process. So, I evaluate and predict the patient¡¦s satisfaction & loyalty under the term of outpatient service process. This study took the example of the outpatient of a provincial community hospital. We use the convenient sample method, and totally got the 222 efficient questionnaires. We do verity the seven outpatient service process with factor analysis. This study has several following remarkable results. The demographic factors have no statistical difference with outpatient service process quality, total satisfaction and consumer loyalty. There is positive correlation between quality of outpatient service process and customer satisfaction. The quality of outpatient service process has a positive impact on consumer loyalty. And the consumer satisfaction exerts a positive influence on the consumer loyalty. With the application of multiple regression analysis, the outpatient service process can efficiently predict consumer satisfaction & loyalty.

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The aim of the study was to analyse and to evaluate ethical climate in Kaunas Sanciai outpatient clinic. Tasks – to evaluate ethical climate in Kaunas Sanciai outpatient clinic; to determine and evaluate ethical climate relationship between varies workers group depending from age, education, work expierence; to identify mostly occurred ethical disturbances in Kaunas Sanciai outpatient clinic. Methods. Investigative were workers (n=237) of Kaunas Sanciai outpatient clinic, interviewed in October-November 2005. The data analysis was performed in 233 (98.3%) persons, using MS Excel and EpiInfo 6.0 statistical programme packages. Results. The major part of Kaunas Sanciai outpatient clinic workers the ethical climate evaluate positive: 77.3% respondents answer, that in the outpatient clinic predominant confidence and honor ambience, 91.9% of persons answer, that each workers committed for own decisions, 73.0% of respondents answer, that predominant friendliness, 67.8% of workers aggreed with affirmation, that the directors of outpatient clinic promote ethical behavior, so the directors are ethical decorum example in 85.5% of persons. Majority (81.1%) respondents answer, that in the outpatient clinic necessary organization members ethical education. Majority of youngest persons and working until one year disagreed with affirmation, that each workers commited for own decision, that in the outpatient clinic predominant friendliness, that organization directors promote workers ethical... [to full text]

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Thesis (M.H.A.)--University of Michigan, 1966.