The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid...The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid and private insurance plans are developing similar programs. These programs reflect a change in pay or incentives in the direction of primary and ambulatory care at the community level. This study described the use of nursing case management as a tool for monitoring and coordinating the impact of value based programs at the community level. It suggested that, under these programs, nursing case management can contribute to reduction of hospital admissions/discharges, emergency department visits, and hospital readmissions. This can be accomplished through monitoring of utilization levels for these indicators. These are major objectives of MACRA and related programs. The study also suggested that nursing case management can contribute to the development of new programs, such as Complex Care, as a means of reaching these objectives. The study included estimates of the costs and benefits of using case management to reduce hospital admissions for low severity of illness patients at the community level. It suggested that the service can provide important opportunities for health planning and development in this area.展开更多
Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on ...Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain,pain assessment,pharmacological and nonpharmacological management,and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team.Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used.The Clinical Pain Knowledge Test(CPKT)was completed by 135 and 107 nurses from 17 surgical wards pre and post-program,respectively.Two hundred and three patients’medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention,respectively.Documentation of patients’postoperative pain management nursing practice behaviors and pain intensity scores were collected.Results:After the intervention,the CPKT scores of nurses significantly increased from 45.6%±12.3%to 54.2%±10.2%(t=5.786,P<0.001).Nurses’postoperative pain management nursing practice improved,with proportion of pain assessment documentation increased from 59.6%(121/203)to 74.9%(152/203)(χ^(2)=10.746,P=0.001),those using pain intensity assessment tools increased from 81.8%(99/121)to 95.4%(145/152)(χ^(2)=13.079,P<0.001),and intramuscular injection of nonopioids decreased from 12.6%(13/103)to 2.7%(3/111)(χ^(2)=7.598,P=0.006).Patients’average worst pain score on the operation day significantly decreased(Z=-2.486,P=0.013),and scores from the first to the third postoperative day also decreased(Z=-2.172,P=0.030).Conclusions:Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management,improve selected pain management practices,and decrease patients’postoperative pain intensity.展开更多
目的分析目标管理配合优化新绩效管理用于耳鼻咽喉科的效果。方法选取2021年1月—2022年12月莆田九十五医院耳鼻咽喉科的18名护理人员为研究对象。将2021年1—12月实施常规管理措施作为实施前,2022年1—12月实施目标管理配合优化新绩效...目的分析目标管理配合优化新绩效管理用于耳鼻咽喉科的效果。方法选取2021年1月—2022年12月莆田九十五医院耳鼻咽喉科的18名护理人员为研究对象。将2021年1—12月实施常规管理措施作为实施前,2022年1—12月实施目标管理配合优化新绩效管理作为实施后。比较实施前后耳鼻咽喉科的护理工作质量、职业生命质量、护理差错发生率、护理人员满意度。结果(1)实施后护理工作质量各评分高于实施前(P<0.05)。(2)实施后护士职业生命质量(quality of nurses work life scale,QNWL)各评分高于实施前(P<0.05)。(3)实施后护理文书书写错误/遗漏、消毒隔离不彻底、未及时处理突发事件、给药不及时等护理差错总发生率低于实施前(P<0.05)。(4)实施后总满意度为94.44%,高于实施前的66.67%(P<0.05)。结论目标管理配合优化新绩效管理可提升耳鼻咽喉科护理人员的工作质量与职业生命质量,提高管理水平。展开更多
文摘The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid and private insurance plans are developing similar programs. These programs reflect a change in pay or incentives in the direction of primary and ambulatory care at the community level. This study described the use of nursing case management as a tool for monitoring and coordinating the impact of value based programs at the community level. It suggested that, under these programs, nursing case management can contribute to reduction of hospital admissions/discharges, emergency department visits, and hospital readmissions. This can be accomplished through monitoring of utilization levels for these indicators. These are major objectives of MACRA and related programs. The study also suggested that nursing case management can contribute to the development of new programs, such as Complex Care, as a means of reaching these objectives. The study included estimates of the costs and benefits of using case management to reduce hospital admissions for low severity of illness patients at the community level. It suggested that the service can provide important opportunities for health planning and development in this area.
基金supported by the IASP Developing Countries Project:Initiative for Improving Pain Education.
文摘Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain,pain assessment,pharmacological and nonpharmacological management,and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team.Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used.The Clinical Pain Knowledge Test(CPKT)was completed by 135 and 107 nurses from 17 surgical wards pre and post-program,respectively.Two hundred and three patients’medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention,respectively.Documentation of patients’postoperative pain management nursing practice behaviors and pain intensity scores were collected.Results:After the intervention,the CPKT scores of nurses significantly increased from 45.6%±12.3%to 54.2%±10.2%(t=5.786,P<0.001).Nurses’postoperative pain management nursing practice improved,with proportion of pain assessment documentation increased from 59.6%(121/203)to 74.9%(152/203)(χ^(2)=10.746,P=0.001),those using pain intensity assessment tools increased from 81.8%(99/121)to 95.4%(145/152)(χ^(2)=13.079,P<0.001),and intramuscular injection of nonopioids decreased from 12.6%(13/103)to 2.7%(3/111)(χ^(2)=7.598,P=0.006).Patients’average worst pain score on the operation day significantly decreased(Z=-2.486,P=0.013),and scores from the first to the third postoperative day also decreased(Z=-2.172,P=0.030).Conclusions:Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management,improve selected pain management practices,and decrease patients’postoperative pain intensity.
文摘目的分析目标管理配合优化新绩效管理用于耳鼻咽喉科的效果。方法选取2021年1月—2022年12月莆田九十五医院耳鼻咽喉科的18名护理人员为研究对象。将2021年1—12月实施常规管理措施作为实施前,2022年1—12月实施目标管理配合优化新绩效管理作为实施后。比较实施前后耳鼻咽喉科的护理工作质量、职业生命质量、护理差错发生率、护理人员满意度。结果(1)实施后护理工作质量各评分高于实施前(P<0.05)。(2)实施后护士职业生命质量(quality of nurses work life scale,QNWL)各评分高于实施前(P<0.05)。(3)实施后护理文书书写错误/遗漏、消毒隔离不彻底、未及时处理突发事件、给药不及时等护理差错总发生率低于实施前(P<0.05)。(4)实施后总满意度为94.44%,高于实施前的66.67%(P<0.05)。结论目标管理配合优化新绩效管理可提升耳鼻咽喉科护理人员的工作质量与职业生命质量,提高管理水平。
