Showing papers on "Health care published in 1984"

From novice to expert : excellence and power in clinical nursing practice

Abstract: 1. Uncovering the Knowledge Embedded in Clinical Nursing Practice. 2. The Dreyfus Model of Skill Acquisition Applied to Nursing. 3. An Interpretive Approach to Identifying and Describing Clinical Knowledge. 4. The Helping Role. 5. The Teaching-Coaching Function. 6. The Diagnostic and Monitoring Function. 7. Effective Management of Rapidly Changing Situations. 8. Administering and Monitoring Therapeutic Interventions and Regimens. 9. Monitoring and Ensuring the Quality of Health Care Practices. 10. Organizational and Work-Role Competencies. 11. Implications for Research and Clinical Practice. 12. Implications for Career Development and Education. 13. The Quest for a New Identity and New Entitlement in Nursing. 14. Excellence and Power in Clinical Nursing Practice. Epilogue: Practical Applications. References. Glossary. Appendix. Index.

Theoretical Nursing: Development and Progress

Abstract: Inspire your students to be theoretical thinkers, innovative advocates, and agents for change. Focused on cultivating the next generation of scholars, this highly respected classic demystifies theory, charts strategies to use in developing and advancing theory, and provides tools and best practices in evaluating progress in the discipline. Based on the feedback of nursing students, this edition was updated to be more accessible without losing the necessary rigor to foster critical thinking. Meleis provides a developmental and historical review of theoretical nursing and helps readers develop analytic skills and integrate knowledge into a coherent whole. By embarking on the journey of nursing theory, practicing nurses will find ways to improve everyday practice, as well as develop theories that capture their expertise. Highlights of the Sixth Edition Key Topics Paradigms that influenced nursing thought, such as feminism and post-colonialism Nursing Theories, including need , interaction , and outcome theories Social and health care transitions and their influence on advancing nursing knowledge The most updated global definitions of the discipline of nursing and the future of nursing Critical discussions on how different classifications of theories may lead to productive explorations and explanations of the process of clinical judgment and decision making Key Features New online journal articles and case studies give students an opportunity to apply theory to practice. Chapter-ending Reflective Questions expand students' understanding of theory and its impact on nursing today. Separate chapters covering Middle Range Theory and Situation-Specific Theory . This text is complemented by and frequently used with Peterson & Bredow's Middle Range Theories: Application to Nursing Research and Practice . A new two-column design that enhances readability. Doody's Review Services gives this title a Weighted Numerical Score: 89 - 3 Stars! "This is the most exemplary nursing theory title available and it is particularly useful because it is a treasure trove of classic and emerging theorists and their work. The breadth, comprehensiveness, and historical grounding make this a must-have title that is a relevant reference for emerging nursing theorists and researchers, faculty, graduate students, and policy makers." - Doody's Review Service

Culture, health, and illness

Abstract: Preface to the 5th Edition 1. Introduction: the scope of medical anthropology 2. The body: cultural definitions of anatomy and physiology 3. Diet and Nutrition 4. Caring and curing: the sectors of health care 5. Doctor-patient interactions 6. Gender and reproduction 7. Pain and culture 8. Culture and pharmacology: drugs, alcohol and tobacco 9. Ritual and the management of misfortune 10. Cross-cultural psychiatry 11. Cultural aspects of stress and suffering 12. Migration, globalization and health 13. Telemedicine and the Internet 14. New bodies, new selves: genetics and biotechnology 15. Cultural factors in epidemiology 16. The AIDS pandemic 17. Tropical diseases: malaria and leprosy 18. Medical anthropology and global health 19. New research methods in medical anthropology Appendix: Journals and websites Author index Subject index

Krause's Food, Nutrition, & Diet Therapy

Abstract: Comprehensive coverage of basic and clinical nutrition for all health care practitioners Presents normal nutritional requirements and diet therapy for all stages of the life cycle, including pregnancy, childhood, and older adult Includes brand new chapters on the nutritional needs for fitness, in weight control, and in athletic training Diet therapy coverage is complete, with examinations of nutritional needs in such chronic health problems as allergies and arthritis, and acute problems in the hospital, such as trauma, sepsis, burns, surgery, and AIDS A comprehensive instructor's manual provides resources and dozens of case studies

Utilization of health and mental health services. Three Epidemiologic Catchment Area sites.

Abstract: • Utilization of health and mental health services by noninstitutionalized persons aged 18 years and older is examined based on interviews with probability samples of 3,000 to 3,500 persons In each of three sites of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) program: New Haven, Conn, Baltimore, and St Louis. In all three ECAs, 6% to 7% of the adults made a visit during the prior six months for mental health reasons; proportions were considerably higher among persons with recent DSM-III disorders covered by the Diagnostic Interview Schedule (DIS) or severe cognitive impairment. Between 24% and 38% of all ambulatory visits by persons with DIS disorders were to mental health specialists. In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally. The aged infrequently received care from mental health specialists. Visits for mental health reasons varied considerably depending on specific types of DIS disorder.

Variations in physician practice: the role of uncertainty.

Abstract: Prologue: Nothing more underscores the reality that medical care represents a melding of art and science than the wide variation in the use and cost of that care. One of the factors that leads to practice variations is uncertainty in the minds of doctors about how to approach a particular medical problem. David Eddy, who holds a medical degree from the University of Virginia and a doctor of philosophy degree in applied mathematics from Stanford University, has made a professional career of reducing uncertainty in medical practice and helping doctors find their way to the most efficacious treatments for patients. Eddy operates at the intersection of math and medicine, applying probability theory to the uncertainty of approaches to care. Although his pursuits have not always been appreciated by the profession —many of his conclusions cut against the grain of conventional medical judgment—Eddy has been awarded the Manchester Prize by the Operations Research Society of America, the most prestigious honor that...

Social Support and Cancer: Findings Based on Patient Interviews and Their Implications

Abstract: Past research indicates that social support is beneficial to cancer patients in adjusting to the stress of the disease. In this article, a brief review of research on social support is provided as a framework within which support among cancer patients can be examined. Research on cancer is then reviewed, and selected results from an investigation of 79 cancer patients are reported. The findings indicate that: health care providers are particularly important sources of support to cancer patients; of several types, emotional support is seen as especially helpful; and the types of support seen as most helpful by those with cancer depends on who provides them. In addition, variability in stress among cancer patients mediated the frequency of interpersonal problems, and the association between support and various indices of adjustment. Implications of these results for future research on social support in stressed populations, especially cancer patients, are discussed.

Accessibility and Utilization: Geographical Perspectives on Health Care Delivery

Abstract: Geographical Perspectives on Health Care Health Care Delivery Systems Some International Comparisons Access to Health Care Physician Organization, Location and Access to Health Care Measuring the Potential Physical Accessibility of General Practitioner Services Utilization of Health Care Facilities Revealed Accessibility? Jarvis' Law and the Utilization of Mental Health Care Spatial Aspects of Health Care Planning

Factors explaining the use of health care services by the elderly

Abstract: The Anderson model of health services utilization, which relates use of service to predisposing, enabling, and need factors, has not often been applied to an elderly population. In this study, the factors of the Andersen model were used prospectively to predict utilization for a population sample of 1,317 elderly persons. Taken alone, the NEED construct was the most important single predictor of use of physician services, hospitalizations, ambulatory care, and home care. PREDISPOSING factors were better predictors of the use of dental services. Some of the variables studied were not related to utilization in the direction that would have been predicted from previous studies on general populations. Multivariate analyses demonstrated that the three constructs should be applied simultaneously when predicting use of services. These findings can be applied to the specific task of planning services for older people.

Care, the essence of nursing and health

Abstract: No wonder you activities are, reading will be always needed. It is not only to fulfil the duties that you need to finish in deadline time. Reading will encourage your mind and thoughts. Of course, reading will greatly develop your experiences about everything. Reading care the essence of nursing and health is also a way as one of the collective books that gives many advantages. The advantages are not only for you, but for the other peoples with those meaningful benefits.

Illness and culture in contemporary Japan : an anthropological view

Abstract: Health care in contemporary Japan - a modern industrial state with high technology, but a distinctly non-Western cultural tradition - operates on several different levels. In this book Emiko Ohnuki-Tierney provides a detailed and historically informed account of the cultural practices and cultural meaning of health care in urban Japan. In contrast to most ethnomedical studies, this book pays careful attention to everyday hygienic practices and beliefs, as well as presenting a comprehensive picture of formalized medicine, health care aspects of Japanese religions, and biomedicine. These different systems compete with one another at some levels, but are complementary in providing health care to urban Japanese, who often use more than one system simultaneously. As an unequalled portrayal of health care in a modern industrial, but non-Western, setting, it will be of widespread interest to scholars and students of anthropology, medicine, and East Asian studies.

Methodology in behavioral and psychosocial cancer research. Conceptualizing disease impact and treatment outcomes.

Abstract: The focus of assessment of disease impact is moving beyond survival and biomedical outcomes to include a comprehensive set of health status and quality of life concepts. We have discussed four socially relevant concepts that can be thought of as dimensions of health status or well being: physiologic status, personal (physical) functioning, mental health, and social well-being. Quality of life was also discussed briefly as a very global concept encompassing these health status dimensions and a broader set of concepts including finances, housing, and employment. Five categories of measures based on manifest content were also discussed, including measures of disease/diagnostic status, personal functioning, mental health, general health perceptions, and social/role functioning. The physiologic dimension of health is very heterogeneous and includes many concepts and measures that vary largely independently of each other and that differ in terms of their impact on the other dimensions of health status. The physical, mental, and social dimensions of health and well-being also can be measured many different ways, and each can be broken down into distinct concepts that may vary in importance from one study to another. Of these three concepts, social well-being is the most heterogeneous. To assist investigators searching for valid measures of specific health status and quality of life concepts, we recommended formal estimations of measurement models. A preliminary model of 15 health status measures was presented to illustrate the usefulness of such a model.

A randomized trial of A.C.T. (asthma care training) for kids.

Abstract: A randomized control trial of a curriculum, A.C.T. (Asthma Care Training) for Kids, was conducted. Seventy-six children between the ages of 8 and 12 years, whose asthma required treatment with medications at least 25% of the days per month, were randomly assigned to control and experimental groups. The control group received 4 1/2 hours of lecture presentations on asthma and its management. The experimental groups (consisting of four to seven children and their parents) received five 1-hour sessions comprising "the treatment." Children and their parents were interviewed before the sessions and 3, 6, and 12 months after the completion of the experimental treatment. Use of emergency rooms and hospitals was determined by reviewing the records of these patients (all members of the Los Angeles Kaiser Permanente health care system) for the period of 1 year before and 1 year after the treatment. Results include (1) equivalent increases in knowledge and changes in beliefs in both groups, (2) significant changes in the self-reported compliance behaviors of the experimental group only, and (3) significant reductions in emergency room visits and days of hospitalization among those receiving the experimental treatment, compared with the control group. These changes represent an estimated savings of approximately $180 per child per year for those in the experimental group.

The use and costs of Medicare services in the last 2 years of life.

Abstract: This study reports on the use of services by Medicare enrollees who died in 1978. Decedents comprised 5.9 percent of the study group but accounted for 28 percent of Medicare expenditures. The use of services became more intense as death approached. Despite the idea that heroic efforts to prolong life are common, only 6 percent of persons who died had more than $15,000 in Medicare expenses in their last year of life. As shown here, the unique patterns of health care use by decedents and survivors should be fully understood and considered when contemplating changes in the Medicare program.

Applied social psychology

Abstract: I. OVERVIEW. 1. Applying Social Psychology - Typical Features, Roles, and Problems. 2. Theories in Applied Social Psychology. II. METHODS OF OBTAINING KNOWLEDGE. 3. Survey Research - The Quality of Life, and Sexuality. 4. Experiments - Soliciting Donations. 5. Correlational Research - Leadership. 6. Quasi-Experimental Studies - Effects of Television. 7. Evaluation Research - Drug Prevention Programs. III. AREAS OF APPLICATION. 8. Educational Settings - Intergroup Relations and Learning. 9. Diversity Issues - Gender and Ethnicity. 10. Organizational Settings - Job Satisfaction. 11. Environmental Issues - Energy and Resource Conservation. 12. Health and Health Care - Smoking. 13. Mass Communication - Media Content and Effects. 14. Consumer Issues - Advertising. 15. Legal Issues - Research on the Legal System. IV. ACHIEVING SOCIAL CHANGE. 16. Activism for Social Change. 17. Influencing Public Policy. References. Name Index. Subject Index.

Improved neurologic recovery and survival after early defibrillation.

Abstract: Eighty-seven patients who had out-of-hospital cardiac arrests received defibrillating shocks delivered by minimally trained first responders before the arrival of paramedics in a city with short emergency response times. Their outcomes were compared with those of 370 other victims who received only basic life support by first responders until paramedics arrived. Survival was improved by early defibrillation in cases in which there was a delay in initiating cardiopulmonary resuscitation and in which paramedic response times exceeded 9 min; there was 62% survival after early defibrillation by first responders and 27% if first responders provided only basic life support (p less than .02). Neurologic recovery was also improved after early defibrillation. Eighteen of 46 resuscitated patients (39%) receiving early defibrillation were awake at 24 hr compared with 49 of 204 patients (24%) who received only basic life support while awaiting paramedics (p less than .02). Incorporating defibrillation as part of basic life support can reduce both mortality and morbidity from cardiac arrest, even in cities with established, rapidly responding emergency care systems.

Perceived health: age and sex comparisons in a community.

Abstract: The need to find accurate and reliable indicators on which to base the planning, provision, and evaluation of health services gave impetus to the attempt to develop reliable and valid measures of the perceived health status of the consumers of health care. Subjective measures can provide an important complement to traditional statistics by giving direct access to the personal feelings of discomfort or distress that influence the use of health services. Such measures also give meaningful criteria for the evaluation of the efficacy of such services. Self assessments of health obtained from surveys and interviews have consistently found age and sex differences in the tendency to report symptoms, ill-health, disability, visits to doctors, and sickness absence. Many of these data, however, may have been misleading in using instruments of unknown or uncertain validity and reliability. Nevertheless, subjective assessments of health have been shown to have value and to add a dimension to objective measurements of health. They have been considered to be one of the better predictors of mortality and of adjustment to major episodes of illness.

Health Status and the Use of Outpatient Mental Health Services

Abstract: Using data from the RAND Corporation's Health Insurance Study, the authors have linked mental health status (self-reported psychological distress and psychological well-being) to the subsequent use outpatient mental health services delivered by formally trained mental health specialists and general medical providers.

The right to a decent minimum of health care.

Abstract: A consensus that there is a right to a decent minimum of health care pervades recent policy debates and much of the philosophical literature on health care. There are at least three features widely associated with the idea of a right to a decent minimum which, together with the facile consensus that vagueness promotes, help explain its popularity over competing conceptions of the right to health care. First, it is usually assumed that the idea of a decent minimum is to be understood in a society-relative sense. Second, the idea of a decent minimum avoids the excesses of what has been called the strong equal access principle, while still acknowledging a substantive universal right. A third attraction is that since the right to health care must be limited in scope, it should be limited to the ‘most basic’ services, those normally ‘adequate’ for health, or for a ‘decent’ or ‘tolerable’ life.

The Crisis of Physical Illness

Abstract: An acute health crisis is often a key turning point in an individual’s life. The vivid confrontation with a severe physical illness or injury, prolonged treatment and uncertainty, and intense personal strains can have a profound and lasting impact. Most patients cope reasonably well with such a crisis and are able to recover and resume their prior level of functioning. Some individuals, however, are utterly demoralized and suffer serious psychological consequences, whereas others emerge with a more mature outlook and a richer appreciation of life. What factors affect the ultimate psychosocial outcome of a health crisis? Why do some patients continue to struggle under the most harrowing circumstances? What are the major adaptive tasks seriously ill patients encounter? What types of coping skills do they use to promote recovery? Are there common phases or stages through which individuals progress as they negotiate a health crisis? What stressors are encountered by health care professionals and how can they nourish the psychological healing process among patients and their families? We deal with these issues here by considering physical illness as a life crisis and by describing how patients and staff cope with the stress of illness and of treatment.

Hepatitis B Vaccine in Health Care Personnel: Safety, lmmunogenicity, and Indicators of Efficacy

Abstract: In a double-blind trial, we randomly assigned 1330 high-risk health care personnel to receive three 20-µg doses of hepatitis B vaccine or placebo. Among vaccine recipients 58% responded wi...

"Though Much is Taken" -- Reflections on Aging, Health, and Medical Care

Abstract: The Medicare trust funds face huge prospective deficits by the end of this decade.This paper discusses trends in six areas that bear on the Medicare problem: the number of the elderly, their health status, use of medical care, labor force participation, income, and living arrangements. Among the most important findings are: 1) a very large increase since 1965 in life expectancy at age 65; 2) a very large increase since 1976 in real per capita health care expenditures on the elderly relative to expenditures on persons under age 65; 3) a cross-sectional increase with age in per capita health care expenditures that is primarily attributable to very large expenditures in the last year of life; 4) a sharp decrease in labor force participation and a sharp increase in relative income of the elderly since 1965.The paper concludes by raising questions about the need to reconsider the definition of the elderly, the need for more flexible labor market arrangements for older workers, and a need for a social consensus concerning appropriate care of dying patients.

Medical reimbursement computer system

Abstract: A computer system for identifying the most appropriate of the billing categories (Diagnosis Related Groups) prescribed by the a governmental entity as a basis for determining the amount that health care providers, such as hospitals, are to be reimbursed under Medicare and similar programs for services provided to patients. The computer system responds to an initial determination of a category, upon admission of a patient, to list for medical personnel involved in giving care to the patient, such as the attending physician, a few other medically related categories for consideration as diagnosis and treatment proceeds. Only those related categories that can apply to a particular patient are listed for that patient, thereby reducing the time necessary for the physician to review and designate any new category that may be more accurate than the first. When a new category is designated by the attending physician, a new listing is provided the physician with those categories medically related to the newly designated category being listed. A brief review by the physician each day, with a new listing provided by the computer system for the following day's review if the physician designates any change, gives an accurate determination of the most appropriate billing category by the time services to the patient have been completed, such as when a patient leaves a hospital. A billing category determined in a conventional manner by medical records clerical personnel after medical services are ended can then be compared and reconciled with the physician determined category in order to improve the accuracy of the conventional determination.

Health is a Status

Abstract: 6_Perceived health status 7_Perceived health status by age and gender 8_Perceived health status by socio-economic status 9_Low birthweight 10_Communicable diseases 10_1_AIDS 10_2_Incidence of pertussis, measles and hepatitis B 11_Cancer 12_Injuries in road traffic accidents 13_Absence from work due to illness_Self-reported and Compensated 13_1_Self-reported absence from work due to illness 13_2_Compensated absence from work due to illness

Causes for Hospitalization of Nursing Home Residents: The Role of Infection

Abstract: Little is known about specific clinical conditions that lead to hospitalization of nursing home patients To explore this, the authors examined the hospitalizations of 128 nursing home residents and compared them with hospitalizations of 320 patients from the outpatient clinic Hospitalized nursing home patients were older, were admitted to medical services more frequently, and had more nonspecific complaints on admission Nursing home patients were hospitalized most frequently for diseases of the circulatory system (16 per cent), respiratory system (14 per cent), and genitourinary system (12 per cent); clinic patients, for diseases of the circulatory system (25 per cent) and nervous system (10 per cent), neoplasms (10 per cent), and signs and symptoms of ill-defined conditions (10 per cent) The most frequent causes of hospitalization for all patients were diseases of the circulatory system (23 per cent), nervous system (10 per cent), and neoplasms (10 per cent) Among patients from the nursing home, infections caused substantially more admissions (27 per cent) than among patients originating from clinic (12 per cent; P less than 0001) These findings disclose an important opportunity to reduce health care costs and enhance quality of life in the nursing home, particularly through the treatment and control of infections

Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions

Abstract: Although not included originally in the legislative mandate establishing the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, the study Deciding to Forego Life-Sustaining Treatment was undertaken "as a natural outgrowth of our studies on informed consent, the `definition' of death, and access to health care and because it seemed to us to involve some of the most important and troubling ethical and legal questions in modern medicine." In his letter of transmittal to the President, the Commission's chairman goes on to state: Although our study has done nothing to decrease our estimation of the importance of this subject to physicians, patients and their families, we have concluded that the cases that involve true ethical difficulties are many fewer than commonly believed and that the perception of difficulties occurs primarily because of misunderstandings about the dictates of law and ethics. Neither criminal nor