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Accurate diagnosis and effective treatment of leg ulcers reduce prevalence, care time and costs.

https://arctichealth.org/en/permalink/ahliterature81702
Source
J Wound Care. 2006 Jun;15(6):259-62
Publication Type
Article
Date
Jun-2006
Author
Oien R F
Ragnarson Tennvall G.
Author Affiliation
Blekinge Wound Healing Centre, Lyckeby, Sweden. rut.oien@ltblekinge.se
Source
J Wound Care. 2006 Jun;15(6):259-62
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bandages
Community Health Nursing - economics - education
Cost Control
Cost of Illness
Education, Nursing, Continuing
Female
Humans
Leg Ulcer - diagnosis - economics - epidemiology - nursing
Male
Nursing Administration Research
Nursing Assessment
Nursing Staff - economics - education - psychology
Population Surveillance
Practice Guidelines
Prevalence
Questionnaires
Risk factors
Skin Care - economics - nursing
Sweden - epidemiology
Time and Motion Studies
Workload - economics
Wound Healing
Abstract
OBJECTIVE: This long-term follow-up recorded the prevalence, aetiology and treatment of hard-to-heal leg and foot ulcers, and an estimated nurses' time spent providing care, for the years 1994-2005. METHOD: A questionnaire was sent to all district and community nurses in the county of Blekinge, Sweden, during one week in 1994, 1998, 2004 and 2005. Calculating the costs of hard-to-heal leg and foot ulcer care was not a primary aim, but the reduction in prevalence and time spent on wound management suggested it was important to illustrate the economic consequences of these changes over time. RESULTS: Estimated prevalence of hard-to-heal leg and foot ulcers reduced from 0.22% in 1994 to 0.15% in 2005. Treatment time decreased from 1.7 hours per patient per week in 1994 to 1.3 hours in 2005. Annual costs of leg and foot ulcer care reduced by SEK 6.96 million in the study area from 1994 to 2005. CONCLUSION: Improved wound management was demonstrated; leg and foot ulcer prevalence and treatment time were reduced. The results could be attributed to an increased interest in leg and foot ulcer care among staff, which was maintained by repeated questionnaires, continuous education, establishment of a wound healing centre in primary care and wound management recommendations from a multidisciplinary group. The improved ulcer care reduced considerably the annual costs of wound management in the area.
PubMed ID
16802562 View in PubMed
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An innovative enterostomal therapy nurse model of community wound care delivery: a retrospective cost-effectiveness analysis.

https://arctichealth.org/en/permalink/ahliterature158249
Source
J Wound Ostomy Continence Nurs. 2008 Mar-Apr;35(2):169-83; discussion 184-5
Publication Type
Article
Author
Connie Harris
Ronald Shannon
Author Affiliation
Ostomy and Wounds CarePartners ET NOW Division, Kitchener, Ontario, Canada. connie.harris@carepartners.ca
Source
J Wound Ostomy Continence Nurs. 2008 Mar-Apr;35(2):169-83; discussion 184-5
Language
English
Publication Type
Article
Keywords
Aged
Community Health Nursing - organization & administration
Cost-Benefit Analysis
Decision Support Techniques
Female
Humans
Kaplan-Meier Estimate
Male
Models, Nursing
Monte Carlo Method
Nurse's Role
Nursing Administration Research
Nursing Evaluation Research
Ontario
Retrospective Studies
Skin Care - economics - nursing
Specialties, Nursing - organization & administration
Time Factors
Treatment Outcome
Wound Healing
Wounds and Injuries - etiology - nursing
Abstract
A Canadian specialty nursing association identified the necessity to examine the role and impact of enterostomal (ET) nursing in Canada. We completed a retrospective analysis of the cost-effectiveness and benefits of ET nurse-driven resources for the treatment of acute and chronic wounds in the community.
This was a multicenter retrospective pragmatic chart audit of 3 models of nursing care utilizing 4 community nursing agencies and 1 specialty company owned and operated by ET nurses. An analysis was completed using quantitative methods to evaluate healing outcomes, nursing costs, and cost-effectiveness.
Kaplan-Meier estimates were calculated to determine the average time to 100% healing of acute and chronic wounds and total nursing visit costs for treatment in a community setting. Average direct nursing costs related to management of each wound were determined by number of nursing visits and related reimbursement for each visit. A Monte Carlo simulation method was used to help account for costs and benefits in determination of cost-effectiveness between caring groups and the uncertainty from variation between patients and wounds.
Three hundred sixty chronic wounds and 54 acute surgical wound charts were audited. Involvement of a registered nurse (RN) with ET or advanced wound ostomy skills (AWOS) in community-level chronic and acute wound care was associated with lower overall costs mainly due to reduced time to 100% closure of the wound and reduced number of nursing visits. The differences in health benefits and total costs of nursing care between the ET/AWOS and a hybrid group that includes interventions developed by an ET nurse and followed by general visiting nurses that could include both RNs and registered practical nurses is an expected reduction in healing times of 45 days and an expected cost difference of $5927.00 per chronic wound treated. When outcomes were broken into ET/AWOS involvement categories for treatment of chronic wounds, there was a significantly faster time to 100% closure at a lower mean cost as the ET/AWOS involvement increased in the case. For acute wound treatment, the differences in health benefits and total costs between the ET/AWOS and a hybrid nursing care model were an expected reduction in healing times of 95 days and an expected cost difference of $9578.00 per acute wound treated. Again, there was a significant difference in healing times and reduced mean cost as the ET/AWOS became more involved in the treatment. The financial benefit to the Ontario Ministry of Health and Long-Term Care is estimated to increase as the involvement of nurses with ET/AWOS specialty training increases.
The greater the involvement both directly and indirectly of an ET/AWOS nurse in the management of wounds, the greater the savings and the shorter the healing times.
PubMed ID
18344791 View in PubMed
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Are nurses' assessments of their workload affected by non-patient factors? An analysis of the RAFAELA system.

https://arctichealth.org/en/permalink/ahliterature162946
Source
J Nurs Manag. 2007 Jul;15(5):490-9
Publication Type
Article
Date
Jul-2007
Author
Auvo Rauhala
Lisbeth Fagerström
Author Affiliation
Conservative Division, Vaasa Central Hospital, Vaasa, Finland. auvo.rauhala@vshp.fi
Source
J Nurs Manag. 2007 Jul;15(5):490-9
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Attitude of Health Personnel
Bias (epidemiology)
Burnout, Professional - psychology
Factor Analysis, Statistical
Finland
Humans
Inpatients - classification
Job Satisfaction
Linear Models
Needs Assessment - organization & administration
Nurse's Role
Nursing Administration Research
Nursing Methodology Research
Nursing Staff, Hospital - organization & administration - psychology
Personnel Staffing and Scheduling
Questionnaires - standards
Retrospective Studies
Severity of Illness Index
Workload - psychology - statistics & numerical data
Abstract
To identify (1) the contribution of non-patient factors to patient classification systems and (2) the explanatory power of nursing care intensity and non-patient factors to Professional Assessment of Optimal Nursing Care Intensity Level workload.
In the Rainio, Fagerström and Rauhala (RAFAELA) patient classification system, nursing care intensity per nurse is measured daily by the Oulu Patient Classification/Qualisan instrument. The optimal nursing care intensity is determined using Professional Assessment of Optimal Nursing Care Intensity Level instrument. However, nurses' workload may be affected by factors other than nursing care intensity. Therefore, RAFAELA contains 12 non-patient questions.
A retrospective study of all 22 somatic wards of a secondary healthcare hospital in Finland.
Non-patient questions were answered in 26% of 4870 questionnaires. They added to workload in 62%. Eight questions were grouped into four factors: administration; staff resources and mental stress; co-operation within and between units. The explanatory value between Oulu Patient Classification/Qualisan and Professional Assessment of Optimal Nursing Care Intensity Level had a median of 0.45. Including the non-patient questions raised it to 0.55.
Non-patient factors affect the nurses' assessments of their workload, but less than nursing care intensity. They contribute valuable information on the functioning and problems of wards.
PubMed ID
17576247 View in PubMed
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Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system--case study from the general wards of one central hospital.

https://arctichealth.org/en/permalink/ahliterature174365
Source
J Clin Nurs. 2005 Jul;14(6):674-84
Publication Type
Article
Date
Jul-2005
Author
Anna-Kaisa Rainio
Arto E Ohinmaa
Author Affiliation
Development Manager, Vasa Central Hospital, Vasa, Finland. anna-kaisa.rainio@vshp.fi
Source
J Clin Nurs. 2005 Jul;14(6):674-84
Date
Jul-2005
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Benchmarking
Cost Savings
Diagnosis-Related Groups - classification
Direct Service Costs - statistics & numerical data
Efficiency, Organizational
Feasibility Studies
Finland
Health Resources - economics - utilization
Hospital Costs - statistics & numerical data
Hospital Information Systems - organization & administration
Humans
Inpatients - classification
Models, Nursing
Models, organizational
Nurse's Role
Nursing Administration Research
Nursing Assessment - methods
Nursing Service, Hospital - organization & administration
Nursing Staff, Hospital - organization & administration
Personnel Staffing and Scheduling Information Systems - organization & administration
Salaries and Fringe Benefits - economics
Workload - classification
Abstract
RAFAELA is a new Finnish PCS, which is used in several University Hospitals and Central Hospitals and has aroused considerable interest in hospitals in Europe.
The aim of the research is firstly to assess the feasibility of the RAFAELA Patient Classification System (PCS) in nursing staff management and, secondly, whether it can be seen as the transferring of nursing resources between wards according to the information received from nursing care intensity classification.
The material was received from the Central Hospital's 12 general wards between 2000 and 2001. The RAFAELA PCS consists of three different measures: a system measuring patient care intensity, a system recording daily nursing resources, and a system measuring the optimal nursing care intensity/nurse situation. The data were analysed in proportion to the labour costs of nursing work and, from that, we calculated the employer's loss (a situation below the optimal level) and savings (a situation above the optimal level) per ward as both costs and the number of nurses.
In 2000 the wards had on average 77 days below the optimal level and 106 days above it. In 2001 the wards had on average 71 days below the optimal level and 129 above it. Converting all these days to monetary and personnel resources the employer lost 307,745 or 9.84 nurses and saved 369,080 or 11.80 nurses in total in 2000. In 2001 the employer lost in total 242,143 or 7.58 nurses and saved 457,615 or 14.32 nurses. During the time period of the research nursing resources seemed not have been transferred between wards.
RAFAELA PCS is applicable to the allocation of nursing resources but its possibilities have not been entirely used in the researched hospital. The management of nursing work should actively use the information received in nursing care intensity classification and plan and implement the transferring of nursing resources in order to ensure the quality of patient care.
Information on which units resources should be allocated to is needed in the planning of staff resources of the whole hospital. More resources do not solve the managerial problem of the right allocation of resources. If resources are placed wrongly, the problems of daily staff management and cost control continue.
PubMed ID
15946275 View in PubMed
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Balancing professional and personal satisfaction of nurse managers: current and future perspectives in a changing health care system.

https://arctichealth.org/en/permalink/ahliterature183995
Source
J Nurs Manag. 2003 Sep;11(5):321-30
Publication Type
Article
Date
Sep-2003
Author
Karran Thorpe
Robert Loo
Author Affiliation
School of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada. thorpe@uleth.ca
Source
J Nurs Manag. 2003 Sep;11(5):321-30
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Attitude of Health Personnel
Canada
Delivery of Health Care - organization & administration
Delphi Technique
Female
Forecasting
Humans
Job Satisfaction
Male
Middle Aged
National health programs - organization & administration
Needs Assessment
Nurse Administrators - education - organization & administration - psychology
Nurse's Role
Nursing Administration Research
Organizational Innovation
Personal Satisfaction
Personnel Staffing and Scheduling
Professional Competence - standards
Questionnaires
Abstract
The objectives of this research were to explore and describe emerging new roles of First-Line Nurse Managers (F-LNMs i.e. individuals who oversee the daily operations of nursing units, regardless of their titles) in one Canadian province, identify their requisite knowledge, skills, competencies, and determine the training and development needs of these managers.
F-LNMs, recognized as key players in health care systems, face major challenges (e.g. continuing organizational change, lack of resources) daily. These challenges affect their ability to achieve quality work experiences for their staff members and quality of nursing care for their patients and for themselves.
The research design entails a triangulation of investigators (nursing and management), methods (interviews and a Delphi Study), samples (interviews with 26 F-LNMs and a Delphi Study with 62 panelists), and data (qualitative and quantitative). Institutions were randomly selected and then F-LNMs were randomly selected to participate in personal interviews and the remaining F-LNMs, along with nominated senior administrators, were invited to participate in the Delphi Study.
Key findings relate to role changes (e.g. job enlargement and emphasis on efficiency), challenges (e.g. staffing and retention, frustrations), and recommendations for administrators (e.g. provide resources, training and development) and educators (e.g. link education to organizational needs). Ultimately, organizational changes and challenges affect how F-LNMs perceive their future professional (e.g. providing quality of patient care) and personal (e.g. high quality of life) satisfaction levels.
This research suggests that the role of F-LNMs continues to evolve, consistent with the changing health care system. F-LNMs face challenges that compromise performance of their functions as they believe their work should be completed. To enhance satisfaction in their roles, F-LNMs express a desire for balance in their professional and personal lives.
PubMed ID
12930538 View in PubMed
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Benchmarking in nursing care by the RAFAELA patient classification system - a possibility for nurse managers.

https://arctichealth.org/en/permalink/ahliterature161098
Source
J Nurs Manag. 2007 Oct;15(7):683-92
Publication Type
Article
Date
Oct-2007
Author
Lisbeth Fagerström
Auvo Rauhala
Author Affiliation
Vasa Central Hospital, Vasa, Finland. lisbeth.fagerstrom@syh.fi
Source
J Nurs Manag. 2007 Oct;15(7):683-92
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Benchmarking - organization & administration
Cost-Benefit Analysis
Data Interpretation, Statistical
Decision Making, Organizational
Diagnosis-Related Groups
Finland
Hospital Costs - statistics & numerical data
Hospitals, Community
Hospitals, University
Humans
Inpatients - classification - statistics & numerical data
Length of Stay - statistics & numerical data
Needs Assessment - organization & administration
Nurse Administrators - organization & administration
Nurse's Role
Nursing Administration Research
Nursing Service, Hospital - organization & administration
Nursing Staff, Hospital - organization & administration
Nursing, Supervisory - organization & administration
Personnel Staffing and Scheduling - organization & administration
Quality Indicators, Health Care
Resource Allocation - organization & administration
Workload - classification - statistics & numerical data
Abstract
The aim of the study was to explore the possibilities of benchmarking with the RAFAELA system. In this study, comparisons are made between: (1) costs for one nursing care intensity point; (2) the nursing care intensity per nurse; (3) the relationship between nursing care intensity per nurse and (4) the optimal nursing care intensity.
During the period from 1994 to 2000 a new system for patient classification, the RAFAELA system, was developed in Finland.
86 wards from 14 different hospitals in Finland took part in the study.
The costs for one nursing care intensity point on the adults' wards were on average 7.80euro. The average workload was 25.2 nursing care intensity points per nurse. The optimal nursing care intensity was exceeded during 49.5% of the days and under during 20% of the days.
The study shows that benchmarking with the RAFAELA system provides many opportunities for the nurse managers' resource allocation and their personnel administration.
PubMed ID
17897144 View in PubMed
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British Columbia's provincial nursing workload project: evidence to empowerment.

https://arctichealth.org/en/permalink/ahliterature144303
Source
Nurs Leadersh (Tor Ont). 2010 Mar;23(1):54-63
Publication Type
Article
Date
Mar-2010
Author
Maura MacPhee
Karen Jewell
Andrea Wardrop
Ashifa Ahmed
Barbara Mildon
Author Affiliation
University of British Columbia School of Nursing, 2211 Wesbrook Mall, Vancouver, BC. Maura.macphee@nursing.ubc.ca
Source
Nurs Leadersh (Tor Ont). 2010 Mar;23(1):54-63
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
British Columbia
Community-Based Participatory Research
Decision Making, Organizational
Humans
Leadership
Nurse Administrators - organization & administration - psychology
Nurse's Role
Nursing Administration Research
Nursing Methodology Research
Nursing Staff - organization & administration - psychology
Personnel Staffing and Scheduling - organization & administration
Power (Psychology)
Professional Autonomy
Qualitative Research
Quality Assurance, Health Care
Workload - statistics & numerical data
Abstract
This case study describes an ongoing demonstration project that engages nurses and nurse leaders in decision-making with respect to workload management issues at eight practice sites within British Columbia (two per healthcare sector: acute care, long-term care, community health and community mental health). The primary goal of this project is to promote high-quality practice environments by empowering front-line nurses and their leaders: giving them the means to systematically examine and act upon factors that influence their workloads. Examples from practice sites illustrate tangible benefits from the project.
PubMed ID
20383080 View in PubMed
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Canadian public health nurses' job satisfaction.

https://arctichealth.org/en/permalink/ahliterature169350
Source
Public Health Nurs. 2006 May-Jun;23(3):250-5
Publication Type
Article
Author
Maureen F Best
Norma E Thurston
Author Affiliation
Child and Youth Community Health Services, Calgary Health Region, Alberta Children's Hospital, Calgary, Alberta, Canada. maureen.best@calgaryhealthregion.ca
Source
Public Health Nurs. 2006 May-Jun;23(3):250-5
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Career Mobility
Factor Analysis, Statistical
Humans
Interprofessional Relations
Job Description
Job Satisfaction
Nurse's Role - psychology
Nursing Administration Research
Nursing Methodology Research
Nursing Staff - education - organization & administration - psychology
Occupational Health
Professional Autonomy
Public Health Nursing - education - organization & administration
Quality of Life
Questionnaires - standards
Salaries and Fringe Benefits
Time Factors
Urban Population
Workload
Workplace - organization & administration - psychology
Abstract
This study was undertaken to test the applicability of using a standardized questionnaire for measuring public health nurse (PHN) job satisfaction and to determine whether or not scores changed over 30 months. The importance of establishing a method for ongoing measurement of PHN job satisfaction was underscored by changing directions in practice and an emphasis on building public health capacity.
A 30-month interval, repeated measures descriptive survey design was used.
A randomly selected sample of 87 PHNs employed within 1 Canadian regional health authority participated.
The survey questionnaire, the Index of Worklife Satisfaction, was designed to measure the importance of and satisfaction with 6 components of job satisfaction.
Pay and autonomy were the most important components; the order of the 4 remaining components changed from first to second surveys. Professional status, autonomy, and interaction were the most satisfying components; PHN satisfaction with professional status and interaction improved significantly over 30 months. A majority of subjects reported that direct client care/client response/making a difference were worklife aspects providing them with most satisfaction.
A valid, reliable questionnaire suitable for ongoing measurement was tested with PHNs, and baseline levels of their job satisfaction were established.
PubMed ID
16684203 View in PubMed
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Categorical service allocation and barriers to care for children with chronic conditions.

https://arctichealth.org/en/permalink/ahliterature172155
Source
Can J Nurs Res. 2005 Sep;37(3):86-102
Publication Type
Article
Date
Sep-2005
Author
Lynne D Ray
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Lynne.Ray@ualberta.ca
Source
Can J Nurs Res. 2005 Sep;37(3):86-102
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Canada
Child
Chronic Disease - nursing
Community Health Services - organization & administration
Geography
Humans
Nursing Administration Research
Pediatric Nursing
Resource Allocation - methods - trends
Abstract
Parents raising children with chronic conditions face the challenge of locating and coordinating appropriate community-based resources and services for their child. The purpose of this secondary analysis was to determine parents' view of the mechanisms used to allocate health, education, and social services to children with chronic illness and disability and their caregiving families. A thematic analysis was conducted on data from interviews with 30 mothers and 13 fathers. These parents described 11 mechanisms that were used to determine eligibility and/or to ration services: diagnosis, age, technology dependence, severity, functional ability, guardianship status, geographic location, financial resources, judged parental coping, failure to inform parents about available services, and cyclical funding. These mechanisms were complex, inconsistent, and subject to change. Mechanisms that are integrated, proactive, flexible, and fair are needed to reduce parents' workload and to ensure more equitable allocation of services.
PubMed ID
16268091 View in PubMed
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146 records – page 1 of 15.