Facilitating good process in primary palliative care: does the Gold Standards Framework enable quality performance?
(9/17)
BACKGROUND: Palliative care is an important, complex aspect of primary care, requiring a multidisciplinary approach. The Gold Standards Framework (GSF), a programme used by over 3,000 UK practices, aims to facilitate high-quality palliative care through the introduction of systematic clinical and organizational processes. Quality payments for palliative care are available to UK practices which maintain registers and hold multidisciplinary meetings. OBJECTIVES: To explore the effectiveness and sustainability of the implementation of GSF at practice level. METHODS: The study followed a qualitative comparative case study design using in-depth interviews and observational data with 15 practices participating in GSF, from three areas differing in socio-geography. Semi-structured interviews (total 45) with GPs, community nurses and practice managers were supplemented by observation of practice meetings and systems, to provide contextual insights. Transcribed interviews were analysed using a thematic matrix approach and comparisons were made within and between practices. Practices were identified on a continuum of performance (high, medium and minimal) according to the evidence of functioning in palliative care-related activity. RESULTS: Considerable variation existed between practices in both the extent of palliative care-related processes and the effectiveness of inter-professional communication. High-performing practices displayed a clear-shared purpose for palliative care with effective communication, whereas minimal performing practices demonstrated little utilization of basic GSF processes and deficiencies in inter-professional communication. CONCLUSION: Effective palliative care requires good team relationships and robust processes. While GSF can enable such improvements, quality measures focusing on processes alone are inadequate to distinguish good practice, questioning the effectiveness of current quality measures in UK general practice. (+info)
Primary care guidelines: Senior executives' views on changing health centre practices in hypertension treatment.
(10/17)
Patients in a permanent vegetative state or minimally conscious state in the Maine-et-Loire county of France: A cross-sectional, descriptive study.
(12/17)
Every nurse has the opportunity to make a positive impact on the profession through day-to-day advocacy for nurses and the nursing profession. In this article the author defines advocacy; describes advocacy skills every nurse can employ to advocate for a safe and healthy work environment; and explains how nurses can advocate for nursing as part of their daily activity whether they are point-of-care nurses, nurse managers, or nurse educators. The advocacy practices discussed are applicable whether advocating on one's own behalf, for colleagues at the unit level, or for issues at the organizational or system level. (+info)
Critical incidents of trust erosion in leadership of head nurses.
(15/17)
Organizational stress in the hospital: development of a model for diagnosis and prediction.
(16/17)
A model of organizational stress in the hospital was developed and tested. The model utilized measures of organizational climate, supervisory practices, and work group relations as predictors of the amount of role conflict and ambiguity that nurses perceived in providing patient care. Role conflict and ambiguity were treated as variables that intervene between organizational variables and the level of stress that the nursing staff experienced. Nursing stress was viewed as a direct cause of job dissatisfaction and as an indirect cause of absenteeism among the nursing staff. Data from 158 registered nurses, licensed practical nurses, and nursing assistants on seven nursing units in a 1,160-bed private teaching hospital were used to estimate the parameters of a structural equation model. The model was used to predict the results of a survey feedback project designed to change the supervisory style used on the units. Pre- and posttest data from four surgical units were used to validate the model. The findings suggest that, as predicted, supervisory practices that led to more open expression of views and joint problem solving resulted in reduced role conflict, ambiguity, and stress; increased job satisfaction; and lower levels of absenteeism among the nursing staff. (+info)