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Because most research and development for homecare services have focused on providing connections between home and service centers, the goal of the present work is to develop techniques and create realtime communications to connect service centers and homecare workers in mobile environments. A key technical issue for this research is how to overcome the limitation of bandwidth in mobile media and networks. An effort has been made to balance performance of communication and basic demands in telehealth through optimized system design and technical implementation. Implementations using third generation (3G) Freedom Of Mobile multimedia Access (FOMA) and Personal Handyphone System (PHS) were developed and evaluated. We conclude that the system we developed based on 3G FOMA provides sufficient and satisfactory functions for use in homecare services.

As the aging baby boom generation begins to place additional pressures on the health care system and the nursing workforce of the same generation begins to retire, the worsening nursing shortage has the potential to seriously impact the delivery of health care in the United States and is receiving considerable attention nationwide. Although federal initiatives such as the Nurse Reinvestment Act are critical, issues of supply and demand for registered nurses must also be addressed at the state level. In Maine, nursing leadership has partnered with state policy makers and health care industry leaders in a multi-year initiative that has included the nursing community's envisioning its "preferred future," formal data collection on the nursing workforce, ongoing education of the Maine State Legislature about the nursing shortage, and legislative initiatives.

The purpose of this study was to measure the influence of professional nursing practice (PNP) on global hospital performance (GHP). Evidence links PNP and positive outcomes for patients and nurses, however, little is known about PNP influence on GHP measures used for patient decision-making and hospital management resource allocation decisions. A quantitative study using multiple regression analysis to predict a composite measure of GHP was conducted. Two survey instruments measuring perspectives of the PNP environment were completed by 1815 (31.3%) Registered Nurses (RN) and 28 (100%) Senior Nurse Executives (SNE) at 28 northeastern US hospitals. Secondary data provided organizational attributes. The degree of PNP was consistently reported by RNs and SNEs. When regressed with organizational factors, PNP was not a significant predictor of GHP. Better GHP was associated with lower lengths of stay, lower profitability, less admission growth, and non-health system affiliation. Further research is needed to define a nursing-sensitive GHP measure.

The purpose of this study is to conduct a comprehensive review of the factors affecting the successful implementation of Mobile Nursing Stations (MNS) by case study. A thorough validation process was used to identify the nine critical factors which influence the implementation of MNS, including the degree of peer competition, governmental and insurance policies, the Information Technology (IT) infrastructure, vendor selection, a clinical champion, top management support, task communications, user participation and training issues. The results of this study can enhance managements' understanding of the complete possibilities for the utilisation of MNS.

Educational and service partnerships are not new, but many of these partnerships occurred in the same town or state in the past. Today, with the heightened use of technology, these partnerships are spanning the globe (e.g., outsourcing of services is growing, with India becoming the call center for the world). What does this global flattening trend mean for nursing education and service? How will this trend impact nursing faculty and service shortages? We explored the current global flattening and its use as a potential strategy to combat nursing workforce issues.

This study aimed to conceptualize the dimensioning of nursing staff, as it is understood by professionals who realize this task, and also to reveal their aim and use of estimation of nursing human resources. It is a descriptive and exploratory study with a qualitative approach analyzed through Content analysis. The definition obtained corresponds to those found in literature and, as to its aim, it serves to preview the number of professionals; to guarantee the operation of the nursing work; to attend clients' expectations regarding their needs; to provide personnel and to guarantee their allocation in the work scale. As to the use of this definition in personnel management, it provides a justification to increase staff through new contracts.

Telehealth can provide powerful self-management tools for patients with chronic illness. A methodological framework for evaluating nurse case manager workflow is proposed. The framework focuses on work practices, cognitive tasks and artifacts. It is illustrated in the context of an analysis of telehealth video visits. There is a need to better understand the dimensions of complexity in order to engineer a more optimal user experience and enhance the nurse-patient interaction.

Hepatitis C is a chronic viral infection, which can progress to cirrhosis, liver failure, liver cancer and death. This article describes a model implemented to improve the care of people with hepatitis C in Calderdale and Huddersfield. The aim was to design a model of care based on patient need and create a flexible hepatitis C testing service for current and former injecting drug users. The new service concentrated on three elements: developing the local hepatitis C support group; introducing an integrated care pathway and booklet for assessing patients on treatment for hepatitis C; and implementing a viral hepatitis clinical nurse specialist role in the local drug and alcohol action team.

Introduction: Australian remote area nurses (RANs) are specialist advanced practice nurses. They work in unique, challenging and sometimes dangerous environments to provide a diverse range of healthcare services to remote and predominantly Aboriginal communities. There is an emerging skills gap in the remote nursing workforce as experienced and qualified RANs leave this demanding practice. There is a shortage of new nurses interested in working in these areas, and many of those who enter remote practice leave after a short time. Distance management was examined in order to gain a better understanding of its effects on the retention of RANs in the Australian states of Northern Territory (NT), Western Australia (WA) and South Australia (SA). Distance management in this context occurs when the health service's line management team is located geographically distant from the workplace they are managing., Methods: The study used a mixed method design, with a combination of anonymous surveys and interviews conducted by telephone and face to face. Qualitative and quantitative data were collected. The data were thematically analysed and basic descriptive statistics were also used. All RANs who worked in government and other non-Aboriginal controlled remote health services in NT, SA and WA were included in the sample. Sixty-one RANs (anonymous survey, 55% response rate) and 26 ex-RANs (telephone interview) participated in the research. The ex-RANs were sampled using a snowball technique where interviewees recommended former colleagues for interview. Nine nursing executives with expertise in distance management of remote health services also contributed (face-to-face interview), and they are referred to as 'the experts'., Results: Respondents expressed a dichotomy in their reactions to remote area nursing. On one hand, they expressed a strong sense of pleasure and satisfaction in the nature of their work; while, on the other, they expressed dissatisfaction with aspects of infrastructure, support and management practices. Positive aspects included autonomy of practice, working in a small team, cross-cultural practice, and the beauty and isolation of the setting. Negative aspects included poor orientation, high stress, inadequate resources, poor systems, unrealistic expectations from communities and managers leading to excessive workload, and perceived lack of support from management. The greatest negative issue raised was poor handling of leave replacement, where RANs on leave were not replaced with appropriately qualified and skilled nurses. Respondents noted a frequent change in managers, and reported that the lack of stability in management contributed to lack of support for both RANs and their managers. Lack of support from managers was frequently cited as a main cause for ex-RANs leaving their employment. Despite this, almost all respondents indicated a willingness to remain in the remote workforce if possible. Experts noted that where management was dysfunctional, RAN retention rates fell. They also acknowledged the need for good communication, interpersonal skills, availability of staff development, leave, relief staff, feedback, debriefing, professional support and working conditions. Experts believed managers should make use of available and emerging technology to communicate with RANs, and work to improve RANs' understanding of the role of the management team., Conclusions: Remote Australian Aboriginal communities are mainly served by RANs in a health system that is sometimes ill-equipped and at times poorly managed. The theme of a second-class health system being serviced by RANs who felt they were treated as second-class health practitioners appeared throughout the data. Poor distance management practices may contribute to the high turnover of staff in remote Australia. Retention of RANs may increase with better managerial practices, such as effective communication and leadership, staffing replacement and leave, prompt attention to infrastructure issues, and staff development and appraisal. These are the keys to ensuring that RANs feel supported and valued. Remote area nursing is a rewarding career and, with systemic support, RANs may stay longer in remote practice.

The purpose is to promote the reflection concerning the family role and the evidence of nursing practice, in hospital discharge of the elderly patient. In the settings where elderly patients prevail, the family must be valorised as a partner to guarantee the continuity of care when they return home. A communication strategy concerning what the meaning of being a nurse is and what she/he does, can contribute to unveil the role of nursing in the promotion of health and the quality of life of patients and their families.

This qualitative study aimed to understand how women having an abortion experience the nursing care they receive. The statements of 13 hospitalized women were analyzed through content analysis. The central category "Nursing care experienced in situations of abortion" was constituted from 4 subcategories: care centered in physical needs; fear of judgment in abortion situations; legal aspects defining care; the need for support in abortion situations. These women identified nursing care as based on physical aspects, without contemplating their individuality and specificities. Results indicated the need to create an environment that stimulates listening, helping these women to elaborate their feelings and allowing professionals to behave closer to these women's reality, in order to reduce their own desires and conflicts and contemplate the integrality of care.

Governments across Canada and internationally are implementing nurse telephone advice services to their populations as a means to address healthcare access issues. This paper briefly reviews the international and Canadian history of telephone nursing services and outlines the research that has established the relative safety of these services to patients. The standards, competencies and decision systems that support safe tele-practice are reviewed. The paper focuses on the realities of this emerging nursing practice. A number of concerns related to the marriage of clinical practice and call centres are identified that require further dialogue, research and debate within the profession. The call centre environment can lead to a focus on efficiency measures, such as call length and quick turnaround to the next call, without evidence to ensure that these are safe or desirable standards. Quality of work life for staff in call centres is also raised as an issue that requires more research and dialogue. Other issues include cross-jurisdictional licensure, patient safety, privatization and the differing models of telephone nursing services that are being implemented in Canada.

Policy and procedure manuals are essential to establishing standards of practice and ensuring quality of care to students and families. The Olathe District Schools (Kansas) Technology Department created the Virtual File Cabinet to provide online access to employee policies, school board policies, forms, and other documents. A task force of school nurses was formed to convert the nursing department's policies, procedures, protocols, and forms from hard copy to electronic format and make them available on the district's Virtual File Cabinet. Having the policy and procedure manuals in electronic format allows for quick access and ease in updating information, thereby guaranteeing the school nurses have access to the most current information. Cost savings were realized by reducing the amount of paper and staff time needed to copy, collate, and assemble materials.

Hurricanes Katrina and Rita forced many individuals along the coast of Texas and Louisiana to seek shelter inland. Among the evacuees were residents with special needs and residents of nursing homes and group homes caring for mentally retarded and physically disabled persons. Many nurses volunteered to provide health care for those in need. This article discusses challenges and opportunities that were encountered by nurses volunteering in special-needs shelters. Issues related to human and physical resources, patient care, and confidentiality are discussed including lessons learned. As nurses who cared for evacuees in the shelter, it is hoped some of the lessons learned can be utilized in future disasters.

A system of performance management based on the one used by the New York Police Department has been introduced into a Kent trust. Now the hospital's matrons are answerable for what goes on in their area.

To determine the research priorities of oncology nurses in the Republic of Ireland, a descriptive survey study was undertaken at a national oncology specialist center. The center's nurses (N = 119) were invited to participate in the study, and a 66% (n = 79) response rate was obtained. The research priority areas identified were concentrated around nurse-led care and the effectiveness of nurse-led services in areas such as pain management. Communication, information, and continuity of care issues and stress and burnout in oncology nursing were also among the top priorities selected. Quality of life and radiotherapy were the most important themes that emerged in the open-question section of the questionnaire. The result of this study provides important insights and direction for the development of oncology nursing research in the Republic of Ireland. It also adds to the international literature on research priorities across different jurisdictions.

Objectives: To gather data that would help a parish nurse network to better understand its participants and to explore differences between parish nurses who had completed the basic preparation class versus those who had not in terms of engagement in activities. DESIGN, SAMPLE, AND MEASUREMENTS: A mail survey, including items related to communal orientation, was developed and sent to members of a state-wide parish nurse network (n=265), with 165 surveys returned for a 62% response rate for this descriptive study., Results: Approximately half of the parish nurses indicated that they entered this specialty through church contacts (27.0%) or through the encouragement of family/friends (22.7%). Nurses not completing parish nursing education/training (47%) were significantly more likely to (a) be younger (55 vs. 59 years of age), (b) work fewer hours (8 vs. 16), and (c) provide fewer activities/services for their congregations (4.8 vs. 6.2). Overall, the nurses described themselves as being "communally oriented," that is, desiring to give and receive benefits in response to others' needs., Conclusions: The findings support previous speculations that some self-identified parish nurses function in an "associate" role. Such associates lack the basic preparation class in parish nursing and work fewer hours each month.

The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.

The authors describe an original patient Safety Platform Model. The model identifies the broad components involved in patient safety initiatives and outlines their relationship to one another. A case example of how the model can be used is given as the authors describe a falls-prevention program.

This report presents a summary of the findings from the National Network for Nurse Managed Health Centers Data Consensus Conference. Nationally, nurse-managed health centers are increasingly offering communities another option for access to high-quality primary care. The lack of agreed upon, standardized data elements for these centers has limited the ability to present clear information about their contributions as well as to inform policy related to their support and development. Fifty-three national invitees came to consensus in Washington, DC on the critical data elements for a national database for nurse-managed health centers. This database includes both clinical and financial/business practices elements. Consensus was not reached around some clinical areas. These areas are briefly discussed as well as the plans for next stages of data collection.

To evaluate nurses' priorities for health system reconstruction and professional development in Iraq, a survey of 744 Iraqi nurses was conducted, with the research process managed via the Internet. Seven definite priorities emerged along with significant differences in priorities related to years of experience, age, speciality area of nursing practice, gender, level of education, and geographic location of practice. Results indicate that nurses should be included in health system reconstruction processes and that support for the development of the nursing profession should be included in the plan for overall reconstruction.

A diagnosis of retinoblastoma is devastating not only for the parents of the children but also for the ophthalmic staff who are involved in the provision of care. In Auckland, New Zealand, the Ophthalmology Department provides specialist ophthalmic care for children and their families diagnosed with retinoblastoma. It became clear to nurses with an interest in retinoblastoma that the service provided was not meeting the needs of patients and families, particularly since the numbers had increased over the past two years. Improving our service was essential, but it had to be done in a cost-effective way. We have been successful in implementing a dedicated support network and service for these patients and families with very little additional resources, and we are extremely proud of these achievements.

We review nursing and health services research on health care organizations over the period 1950 through 2004 to reveal the contribution of nursing to this field. Notwithstanding this rich tradition and the unique perspective of nursing researchers grounded in patient care production processes, the following gaps in nursing research remain: (1) the lack of theoretical frameworks about organizational factors relating to internal work processes; (2) the need for sophisticated methodologies to guide empirical investigations; (3) the difficulty in understanding how organizations adapt models for patient care delivery in response to market forces; (4) the paucity of attention to the impact of new technologies on the organization of patient care work processes. Given nurses' deep understanding of the inner workings of health care facilities, we hope to see an increasing number of research programs that tackle these deficiencies.

Access to personal health services is only possible if there are an adequate number and distribution of qualified nurses. However, most work on access has been conceptualized as access to physician services or particular types of settings such as hospital care, not as access to nurses. In this paper I have used the Institute of Medicine Access framework to conceptualize the relationship of the nursing workforce to several aspects of access, and evaluated both the current state of research and existing gaps. Some of the gaps identified in the research that need to be included in a health services research agenda for nursing are: (1) the effect of regional market factors (such as physician ratios and poverty), or attitudes on the supply of nurses; (2) the lack of a critical analysis of staffing and outcome research, and measures of utilization and access specific to nurses in a variety of settings; (3) the need for more and better data to evaluate nurse career patterns, nursing workforce educational capacity, and effectiveness; and (4) relevant workforce policies.

Health services research has led to exciting new findings about the critical importance of the amount and type of nursing staff in nursing homes for improving the processes and outcomes of care. This paper reviews recent theoretical and research issues and outlines areas where research is needed. The nursing home research agenda for the future needs to concentrate on: (1) the relationship between structural measures of nursing (eg, staffing levels, education, turnover rates) and the outcomes and processes of care; (2) adequate processes of care and ways to improve the reliability of clinical outcome measures; (3) better ways to risk-adjust for resident characteristics; (4) the impact of nursing home characteristics (eg, ownership) and public policies (eg, reimbursement) on structural factors, processes, and outcomes; and (5) cost-effectiveness studies of nursing care at the organizational or system level.

Economic necessity constrains health-care expenditure and waiting lists for hospital treatments remain high. As a result, more care is delivered via alternative means, such as same-day surgery initiatives and home-care programmes. Acute care delivered in the home to patients who would otherwise require hospitalization is becoming an increasingly acceptable means of treatment. These Hospital-in-the-Home programmes offer increased comfort while delivering comparable outcomes to many patient groups. The purpose of this paper is to generate discussion concerning the tensions that exist for nurses who practice in the home under the auspices of acute-care institutions. Data drawn from field work that formed part of a critical ethnography is used to generate the discussion. The larger research project explored the constructions of the role of the nurse in four Hospital-in-the-Home programmes in Victoria, Australia. It will be argued that there is significant pressure exerted upon nurses to support the imperative to reduce bed days in acute hospitals by transferring people to their home. At times, this agenda clashes with the nurses' professional commitment to provide holistic patient care, yet the dilemmas are largely unacknowledged and/or unrecognized by the nurses despite the tension they generate.

Political, economical and social changes which are continuously occurring in today's society have a decisive influence on health. Of particular importance are those changes related to the aging of the population, morbidity and the prevalence of chronic diseases which create significant health problems which in turn present significant challenges to curative type medicine. Scientific and technological advances permit a higher degree of sophistication for treatments, increasing life expectancy while at the same time posing questions which must be answered.