Delivering specialized palliative care in the community: a new role for nurse practitioners.

The rising population of older Americans with advanced illness challenges current care delivery models. We use the metaphor of advanced illness as a difficult journey and propose a specific role, that of the "OACIS NP [nurse practitioner]," who helps provide a place of refuge during this journey. "OACIS" is an acronym for Optimizing Advanced Complex Illness Support, a program to provide home-based palliative medical care.

Hourly rounding: challenges with implementation of an evidence-based process.

Introduction of an evidence-based practice change, such as hourly rounding, can be difficult in the hospital setting. This study used ethnographic methods to examine problems with the implementation of hourly rounding on 2 similar inpatient units at our hospital. Results indicate that careful planning, communication, implementation, and evaluation are required for successful implementation of a nursing practice change.

The "dance" continues ... evaluating differences in call bell use between patients in private rooms and patients in double rooms using ethnography.

Staff response to patient call bells is a communication issue that influences patient assessment of care quality and satisfaction. An ethnographic, grounded theory approach was used to examine nurses and nursing support staff perspectives about call bell use on single- versus double-patient-room units. We used the dance metaphor to describe differences in staff behaviors related to answering call bells on the 2 units in the study.

Understanding the role of the promotora in a Latino diabetes education program.

We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community.

Using rapid assessment to evaluate noise on an in-patient unit.

Rapid assessment was used to evaluate a noise problem on a busy, high-traffic, high-acuity medical/surgical telemetry unit over a 4-week period. Six sources of environmental noise were identified including conversational noise, noise from doors, noise from housekeeping activities, noise from the pneumatic message tube station, hallway noise, and miscellaneous noise. Our study also demonstrates the value of rapid-assessment methodology for the evaluation of clinical problems such as noise.

Becoming a leader in patient satisfaction: changing the culture of care in an academic community hospital.

In the context of the current health care payer system, quality of care standards, financial incentives and consumer choice are not well aligned, yet competition for increased admissions has become a matter of survival. Satisfaction and loyalty are two constructs that are the most meaningful measures in the context of sustaining and increasing admissions. Lehigh Valley Hospital and Health Network (LVHHN) launched an ambitious patient satisfaction improvement initiative in 2001.

Cognitive versus technical debriefing after simulation training.

Background: Recent literature describes "cognitive dispositions to respond" (CDRs) that may lead physicians to err in their clinical reasoning.

Objectives: To assess learner perception of high-fidelity mannequin-based simulation and debriefing to improve understanding of CDRs.

Methods: Emergency medicine (EM) residents were exposed to two simulations designed to bring out the CDR concept known as "vertical line failure.

Using simulation to instruct emergency medicine residents in cognitive forcing strategies.

Purpose: Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance.

Method: The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002-03.