Chondrosarcoma of the proximal phalanx.

An 87-year-old male presented with a painless, large mass on the dorsum of the left foot. He reported that the mass had first appeared 10 years ago and now had become so large that he could no longer tie his shoe. The mass originated from the proximal aspect of the second digit, encompassing the second web space and distal one third of the second and third metatarsals.

Should circulating anticoagulant [AKA anti-phospholipid] assays be a routine component of well-patient assessment?

Circulating anticoagulants are a major risk factor for thrombotic problems (eg, myocardial infarction, stroke) and pregnancy complications. The authors present a retrospective survey of anticardiolipin antibody and lupus anticoagulant in 200 consecutive patients presenting to their office.

Quality improvement through data analysis. Concepts and applications.

Nurse executives play a key role in quality management and need a working knowledge of which data collection and improvement tools to use. This knowledge insures effective analysis and decision making necessary to drive department and organizational transformation through quality improvement programs. The author presents the most frequently used tools for quality improvement, with a focus on applications in practice.

Journal club: a tool for health care management and development.

While the journal club concept has its roots in medical practice, the premise of the concept can easily and effectively be assimilated into health care management practice. Health care executives and managers can greatly facilitate the journal club process by establishing a solid methodology for article presentations that focuses on critical and timely issues related to health care management. With upper management support and member commitment, the journal club can be a powerful vehicle for ongoing management and personal career development.

Legal and ethical issues in HIV testing, Part 2.

In part 1 of this two-part series, legal and ethical issues in HIV testing were examined, such as the ELISA test, informed consent, confidentiality, and mandatory vs. voluntary testing. In this article, the author presents the most important legal and ethical concerns related to legislation for testing, testing in the workplace, Centers for Disease Control guidelines and recommendations, ethical analysis, and implications for nurse executives.

Legal and ethical issues in HIV testing, Part 1.

HIV antibody testing presents multiple and complex legal and ethical issues. Nurse executives must be knowledgeable about these issues and their potential impact on administrative practice. In this two-part series, the author presents legal and ethical issues related to testing.

Combining epidural fentanyl and lidocaine for postoperative pain.

Fifteen patients undergoing total hip and total knee replacement were studied prospectively to evaluate postoperative pain relief provided by an epidural infusion of fentanyl citrate, with and without lidocaine hydrochloride, and changes in arterial flow to the lower extremities. The patients were randomly placed in three groups: group 1 received epidural fentanyl, 5 micrograms/mL; group 2 received epidural fentanyl, 5 micrograms/mL with 0.75% solution of lidocaine; and group 3 received epidural fentanyl, 5 micrograms/mL with 1.

The nurse executive and the governing body. Synergy for a new era.

Nurse executives play a vital role in the overall governance of healthcare organizations, and many participate on governing boards. However, we lack a model for effective governing-body relations and contributions. The author presents major functions of the governing body with emphasis on the critical elements provided by the nurse executive.

Quality circles: the nurse executive as mentor.

Changes within and around the health care environment are forcing health care executives to reexamine their managerial and leadership styles to confront the resulting turbulence. The nurse executive is charged with the profound responsibility of directing the delivery of nursing care throughout the organization. Care delivered today must be of high quality.

Advanced directives. In search of self-determination.

Patients are seeking self-determination in health-care through the use of advanced directives. The author discusses advanced directives focusing on patient rights in decision making, autonomy, and the right to refuse life-sustaining treatment. Highlighted is the Patient Self-Determination Act of 1990, including strategies for its implementation in healthcare agencies.

Organ donation and transplantation: an ethical analysis.

The experience of developing and implementing an organ procurement program for a health care agency is most rewarding. Being so deeply involved in the program development forces one to look at the ethical issues head on in an attempt to deal with them personally. Rather than just study the ethical issues at hand, participation in a program allows one to examine the issues in practice.

Management compensation. A reward systems approach.

Across the nation, businesses are rethinking the way performance is rewarded. We are witnessing the emergence of newer, more innovative compensation systems. Today's nurse executive is challenged to design systems for management compensation that reward achievement, performance, and contribution.

Postoperative analgesia with epidural fentanyl.

A retrospective analysis of 133 patients who received continuous epidural fentanyl for postoperative analgesia is presented. Using a concentration of 5 micrograms/mL of fentanyl, patients received continuous epidural infusions for 24 to 72 hours postoperatively. The average rate of infusion was 60 micrograms/h.

The social climate scale. A tool for organizational change and development.

The positive outcomes of the changed healthcare environment are now being realized. The present decade will influence more change and development in organizations and nursing practice to solidify the advances of such outcomes. The effects of outcomes on the work environment and job satisfaction of nurses now must be analyzed.

Redesigning management roles. The executive challenge.

The revolutionary changes that have occurred in healthcare during the past decade challenge nurse executives to analyze and redesign managerial roles. To confront future change and developments in nursing and management practice, the role of the first-line nurse manager must take on new dimensions to facilitate quality outcomes in patient care and empowerment of nurses at all levels of practice. The author presents a model of job redesign for nurse managers with emphasis on the motivational approach.

Physician bonding. The role of the nurse executive.

Nurse executives know the significant contributions physicians make to patient care revenues. Healthcare agencies are in fierce competition to attract and retain physicians. The development of a physician "bonding" program is an innovative strategy to build physician loyalty and insure use of agency services.