Developing and Implementing Self-Direction Programs and Policies: A Handbook

Provides a guide to designing, implementing, and evaluating service delivery models that allow public program participants to manage their own care services and supports. Outlines elements of employer and budget authorities, enrollment, and counseling

Health of children and young people in secure settings

This small-scale descriptive study was commissioned by the Children and Young People's Public Health team within the Department of Health, in partnership with Offender Health, in order to inform preparation and implementation of an Offender Health Strategy document for children and young people. The overall aim was to review what is currently known about healthcare for children and young people in the secure estate, covering all three types of settings (Young Offender Institution, Secure Training Centre and Secure Children's Home) and all aspects of health, but with a particular focus on physical health since more is already known about mental health and substance misuse among young people in secure settings

Comparing Two Surgical Outcomes: Minithoracotomy or Full Sternotomy in Coronary Artery Bypass Grafting Surgery

Cardiovascular diseases and heart-related conditions can be life-threatening; however, some cardiovascular conditions can be managed with open heart surgery. Coronary artery bypass grafting (CABG) is the most common type of heart surgery performed on adults. There are two different surgical procedures to correct cardiac defects: mini-thoracotomy and full sternotomy. Mini thoracotomy approach has been shown to reduce complications, such as pneumonia, excessive blood loss, and infection in mitral valve repair surgeries. However, little research has been done to compare these two surgical approaches performed for patients undergoing coronary artery bypass grafting (CABG). Specifically, there is inadequate data to compare these two surgical approaches in relation to length of stay and duration of ventilator use. The purpose of this study was to compare the surgical outcomes of mini-thoracotomy and full sternotomy in patients undergoing CABG surgeries. A retrospective chart review was conducted from an archival data (2010 to 2016) in patients undergoing CABG surgeries with either a mini-thoracotomy or full sternotomy approach. Included were patients with coronary artery blockages who required CABG surgeries. A one-way ANOVA and independent sample t-test were used for statistical analysis. Results showed that, there was no significant difference in days of hospitalization in those receiving mini-thoracotomy (M= 10.75, SD=10.25) as compared to those who receiving full- sternotomy (M=11.91, SD= 10.03), F (1,537) = 1.17, p = .23.There was no significant difference in number of hours of ventilation time for mini thoracotomy (M= 13.62, SD= 17.58) and full sternotomy (M= 22.33, SD= 95.96), F (1,537) = .90, p=.34. As the length of hospitalization and duration of ventilation did not differ in both surgical approaches, we can conclude that mini-thoracotomy was very comparable to full-sternotomy in these two areas for patients undergoing coronary artery bypass grafting

Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

A study to determine the effect of progressive patient care on staffing patterns of nursing service

Thesis (M.S.)--Boston Universit

Nurses\u27 Perceptions of Structural Empowerment: A Practice Review Process Pilot

Nurses are professionally and morally obliged to monitor and evaluate nursing practice via active participation in review mechanisms that are designed to promote patient safety and care delivery, thereby improving patient care quality (American Nurses Association [ANA], 1988, 2001, 2004; O\u27Rourke, 2006). The purpose of this Doctor of Nursing Practice (DNP) project was to develop, pilot, and evaluate a nurse practice review process with frontline nurses within Fresno Heart & Surgical Hospital (FHSH), a small specialty hospital, affiliated with Community Medical Centers (CMC) in Fresno, California. A nurse practice algorithm was subsequently developed and structural empowerment was assessed with the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) (Laschinger, Finegan, Shamian, & Wilk, 2001). While there was a small sample size, the DNP project evaluation demonstrated that frontline nurses want to participate in improvement activities within the facility and believed the nurse practice review algorithm would effectively monitor and evaluate nursing practice

A Ward teaching unit on the care of the Cardiac patient

Thesis (Ed.M.)--Boston Universit

One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations

Proposes a framework for meeting patients' cultural and linguistic needs: policies and procedures that support cultural competence, data collection, population-tailored services, and internal and external collaborations. Includes a self-assessment tool