Free and paid medical assistance in the United States News : Part 4

Impaired Quality of Life of Healthy Young Smokers

Impaired Quality of Life of Healthy Young SmokersSome studies have shown that smoking may lead to impairment of health-related quality of life (HRQL). Significant differences in mean scores, as measured by the 36-item short form (SF-36), have been observed between never-smokers, smokers, and ex-smokers in population surveys. Similar results were obtained employing the St. George’s Respiratory Questionnaire in a group of subjects older than 55 years. there
The results of general population surveys and studies including old people can be potentially influenced by unrecognized smoking-related disorders and other comorbidities. So far, no investigation has been done specifically aimed at investigating HRQL in young subjects with a short smoking history. The objective of the present study was to investigate HRQL in a selected sample of healthy young smokers. Continue reading

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Essential Need for Innovative Care Models

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Essential Need for Innovative Care ModelsIn designing a new and more effective structure, the UMass Memorial Medical Center team learned that it needed to communicate more effectively and in the process has strengthened its interdisciplinary relationships. Team members have more consistently come to understand and appreciate the perspective of others and, by constantly focusing on what is best for patients and patients’ families, are better able to resolve conflicts, solve problems, and refocus attention toward teamwork and quality evidence-based, patient-focused care. Only time will tell how successful the virtual department will be. However, it was clearly time for a change because the 20th-century model of delivering critical care has too many flaws, flaws that the IOM says portray all of medicine. www.cheap-asthma-inhalers.com
We suspect that other innovative models remain unreported, and we urge readers to communicate their successes and, yes, failures to the professional community. We challenge readers to engage in this essential work of designing innovative care delivery. Consider what is required so that skilled communication, true collaboration, and patient-focused care can become the norm at your institution.
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Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Acute Care

Appropriately educated and certified acute care nurse practitioners and physician assistants have been recruited to join the clinical teams and work with intensivists, house staff, and nurses to ensure that standards are consistently applied to achieve expert and rapid responses to patients’ short-term needs. In order to facilitate the entry of these care providers into the system in the future, a close collaborative educational and research partnership has been established with the University of Massachusetts Graduate School of Nursing, and a nurse practitioner/physician assistant critical care mentorship program has been established. comments
The need for additional ICU and progressive care beds has been identified, and all disciplines are involved in planning for these expanded services.
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Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Recommendations

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: RecommendationsThe recommendations of the committee are presented to the medical center president and leadership council, who look to the committee for decision-making guidance where critical care is involved. Link
Although the medical directors of each unit shown in Figure 1 still primarily report to the chairs of their respective clinical departments, the days of silo building (ie, noninterdisciplinary, isolationist decision-making behavior) are gone. The critical care community as a whole now monitors and manages all critical care activities and budgetary matters. Activities, results, and/or behavior that fall outside what is expected are monitored in real time and are managed by relying on data-driven peer pressure in collaboration with division chiefs and department chairs. Continue reading

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: A Virtual Critical Care Department

Review all unit-based programs for improving quality and patients’ safety to ensure that collaboration and the evaluation of effectiveness are integral to each program.
Develop a fix-the-ineffective-work-arounds task force to identify and fix as many broken systems as possible. Uncover the root causes of the broken system by inviting and actively listening to input from nurses, physicians, and all affected care providers. Work collaboratively, inviting hospital and nursing administrators to participate in abolishing systems that do not work and designing effective new ones. there
Engage the executive leaders of the organization, including, as appropriate, the chief nursing officer, chief executive officer, and medical directors, in the challenge of transforming all systems for evaluating care providers to include the assessment of communication and collaboration skills. Be sure to reward successful skill acquisition in meaningful ways.
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Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Unit-Based Strategies for the Serious Organization

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Unit-Based Strategies for the Serious OrganizationWhat interdisciplinary strategies could a critical care unit put into action to indicate its seriousness in implementing the AACN standards for healthy work environments with a strong focus on patients and patients’ families? Here are some suggestions for making skilled communication and true collaboration the norm:
•    Use techniques such as SBAR to guide interdisciplinary communication. Link
•    Assemble a small group of nurses, physicians, respiratory care practitioners, pharmacists, and other health-care providers to develop processes for organizing truly collaborative interdisciplinary rounds. Set a 6-month goal by which time no patient will be discussed on rounds without the contribution of the full team.
•    Plan educational programs about new and interesting care strategies that are taught jointly by representatives from at least two disciplines. Invite representatives from every discipline with a role in patients’ care, and students, not just medicine and nursing, to participate and contribute their perspectives.
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Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Research

Techniques such as the situation-background-as-sessment-recommendation (SBAR) model are widely used to increase the effectiveness of communication, especially in critical situations.
Structured forums such as ethics committees are used effectively to support clinicians in resolving disputes, to provide clinicians a broader view of the issues, and to ensure that patients’ values and wishes and, if appropriate, those of the patients’ family members are identified and incorporated.
A high level of personal integrity characterizes the behavior of all team members.
Concerns about competence or the collaborative behaviors of team members are dealt with directly and respectfully so that patients are not harmed and team members receive support to correct communication and practice deficits.
Interdisciplinary educational efforts are the norm for staff education in health care, with research findings from each discipline incorporated into the content of clinical education.
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Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Two Critical Standards

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Two Critical StandardsWe embrace the adoption of all six AACN standards as crucial for transforming the work environment. Yet, two of the standards, skilled communication and true collaboration, seem particularly necessary to achieve the goal of patient-focused care, because communication as well as continuity and concordance with the patients’ wishes are foundational premises of patient-focused care.
Some individuals may achieve some level of genuine patient-focused care even when they practice in a toxic work environment because they are gifted communicators who embrace true collaboration. However, we contend that, at best, their efforts will be hit-or-miss, and such heroic efforts will be impossible to sustain if the environment is not transformed into a model that reflects the AACN standards. The barriers to transforming a toxic environment are indeed massive, but if those barriers are not overcome, Pronovost et al’s notion of “interdependence without integration,” will prevail.
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Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Results

How could we not want those we love to receive care from competent, well-educated practitioners who embrace evidence-based practice and lifelong learning? Would we not expect that our families be treated with respect, their unique needs identified and met, and their wishes honored at the end of life? Continuous quality improvement efforts would drive care processes, and we would do our best to accommodate patients and their families even when, because of their limited knowledge or broken systems, they contribute to the difficulties we face in doing our job well. Source
As president of the ACCP from 2003 to 2004, one of us (R.S.I.) challenged the members who were attending the annual meeting to join a revolution in health care, a revolution that refocuses what we do on the patient. As an organization, the ACCP embraced patient-focused care by having members commit to the following pledge: I will strive to provide patient-focused care wherever and whenever I have the privilege of caring for patients. I will also work to ensure that all health-care systems in which I provide care are patient-focused. Patient-focused care is compassionate, is sensitive to the everyday and special needs of patients and their families, and is based on the best available evidence. It is interdisciplinary, safe, and monitored. To ensure the provision of patient-focused care in my professional environments, I shall willingly embrace the concepts of lifelong learning and continuous quality improvement.
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Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Patient-Focused Care

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Patient-Focused CareLip-service collaboration, on the other hand, is halfhearted. When we say that we want to hear the perspectives of others, we must really listen, and our actions must reflect an expanded worldview. Yet, when the stakes are highest and the potential for disagreement is the greatest, we are at the greatest risk for lip-service collaboration. Source
Therefore, we must agree on the best way to help an anxious or angry family support their critically ill loved one, and we must not respond by limiting their access to the patient. With true collaboration, physicians, nurses, and patients’ family members will figure out together the best ways to communicate, to gain the families’ insights into the patients’ needs, and to harness their healing energies.
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