Building a clinical ladder for ambulatory care

Finding innovative rewards for nursing service will be integral in meeting the challenges of future shortages of nursing staff. A clinical ladder is one tool worth exploring and perfecting to address those challenges. Exploration of a case study demonstrates a method for developing a clinical ladder. Steps and pitfalls in developing a clinical path are illustrated. Future uses, benefits, and opportunities for clinical ladders are suggested.     

Health care reform: current updates and future initiatives for ambulatory care nursing

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.     

Patient intensity in an ambulatory oncology research center: a step forward for the field of ambulatory care

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. In this three-part series the current literature on acuity/intensity tools will be reviewed, and the development of an Ambulatory Intensity System (AIS) to objectively quantify the nursing care will be described.     

Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.     

Nurse entrepreneurship: opportunities in acute care hospitals

"Heartcheck," a new hospital-based program initiated by a nurse clinician, focuses on patient needs. Factors related to the program's success are evaluated from an entrepreneurial perspective.     

IT for green and green IT: A proposed typology of eco-innovation

This article is in support of the development of an ecological economic framework. It discusses, from an interdisciplinary perspective, the increasing use of green IT and their applications (IT for green). IT and sustainable development have had a concomitant rise and reach. The future world emerging from their respective interpretations enables, in both cases, a shift from today's questionable industrial capitalism towards post-industrial capitalism. This paper addresses the following questions: What is known about green IT and IT for green? Are smart solutions (buildings, energy grids, transport) always beneficial to an ecological economy? And, if so, in what ways? In the first part of this article, we analyse the economic, social and environmental impact of IT and argue for the need for green applications of green IT in order to achieve sustainable outcomes. The second part focuses on the managerial dimension of eco-innovation theory and presents one of the distinctive features of green applications of green IT: the collective organisation of innovation. A typology of eco-innovation aimed at reconciling IT development and green growth is then proposed explicitly addressing four kinds of changes towards sustainable development: technological, social, institutional and organisational innovation.     

Thinking outside the exam room: accessing community resources for patients in ambulatory care settings

Patients and families receiving care in the ambulatory care setting have increasingly complex needs, requiring nurses to employ a large variety of resources. Parents of pediatric patients have identified services available through community resources as a high priority, although medical personnel do not tend to appreciate the value of these services. Learning about the services offered by community agencies requires some investment of nursing time, but may result in improved effectiveness of nursing care across an institution or network of ambulatory care nurses.     

Expanded role of nursing in ambulatory managed care. Part I: Literature, role development, and justification

New expanded roles in nursing are developing in response to the health system switch from private, episodic care of individuals to health maintenance organizations (HMO's) focusing on disease prevention and promotion of health for populations of persons with chronic illness. This evaluation project explored the role of the nurse clinician in population and case management at a large HMO in the Northwest United States. In Part I of this two-part series, a literature review, is presented on chronic illness, ambulatory nursing, expanded role nursing, and nursing in HMOs. The development of the expanded role nurse clinician at the managed care organization is also described. Results could be used by HMOs to attract and retain nurses, improve care processes, and decrease costs in ambulatory care.     

IT采纳作用下组织冗余与企业绩效的关系

研究了企业IT采纳作用下组织冗余与企业绩效的关系,考虑了IT采纳水平和IT采纳时间对该关系的调节效果。运用"中国企业信息化500强"中上市公司的面板数据进行验证,发现企业IT采纳实施后,在IT采纳时间和IT采纳水平的调节下,4种类型的组织冗余与企业绩效存在不同的关系。     

我国企业IT投资对审计决策的影响及机理研究

大数据时代背景下企业日渐增加的IT投资对审计环境产生了深刻影响,为此我们考察企业最重要的ERP类IT投资与外部审计决策之间的关系。本文以361家IT投资企业与配对样本进行研究发现:企业IT投资后被出具清洁审计意见的概率没有显著变化,企业IT投资后的内控有效性水平无显著变化,但IT投资使企业外部审计费用显著提高。这表明我国上市公司IT投资对外部审计决策的影响机理在于:当IT投资改变审计环境后,审计师面临的重大错报风险与会计盈余信息质量无显著变化,因此,在IT审计环境下审计师出具的审计意见类型无显著变化;审计收费提高不是由重大错报风险变化引起的,而是由于追加审计程序与学习成本提高导致审计效率降低造成的。     

Nonlinear relationship between health care expenditure and its determinants: a panel smooth transition regression model

This paper employs a panel of 16 OECD countries over the period 1975–2009 to reexamine the health care expenditure (HCE)-income relationship by considering a lagged ratio of public expenditures on health as the transition variable in panel smooth transition regression (PSTR) models. PSTR models can capture the heterogeneity of any individual country, provide more detailed information for policy makers of an individual government, and resolve the insufficient observations problem that frequently appears in annual country-level data. Our empirical results indicate that the relationship between HCE and its determinants, including income, time (trend), and age structure variables, is nonlinear and varies with time and across countries. The time (trend) variable—a proxy for technical progress in health care—has a non-linear impact on HCE. Ignoring the variables—technological change of health care and age structure of population—will result in over-estimates of the income elasticities of HCE. Moreover, HCE behaves as a necessity good, and the income elasticity increases when the five-period lagged ratio of public expenditures on health increases. Clearly, the ratio of government financing on health plays an important role in influencing HCE.     

American Academy of Ambulatory Care Nursing position statement: the role of the registered nurse in ambulatory care

Ambulatory care nurses are leaders in their practice settings and across the continuum of care. They are uniquely qualified to influence organizational standards related to patient safety and care delivery in the ambulatory care setting. The current ambulatory care setting is diverse and multifaceted, requiring nurses highly skilled in patient assessment and with the ability to implement a broad range of nursing interventions in a variety of settings. The future of the American health care system depends upon our ability to utilize RNs to the fullest extent of their expertise, licensure, and certification.     

Scenario building: Uses and abuses

Scenarios hold little interest if they are not pertinent, coherent, and plausible. Although foresight requires a rigorous approach to address complex problems, the tools must also be simple enough to be easily used. Since the mid-1980s, the approach in strategic prospective workshops (a term that reminds us of the participatory nature of the French approach) has proven its effectiveness in meeting these criteria (simple, rigorous and appropriable; i.e., may be appropriated by participants). The authors try to reply to simple and important questions: What is a scenario? How to judge the quality of a scenario? Which strategies for which scenarios? These questions remind us that applications of strategic foresight tools are contingent and modular. They could also involve the stakeholders from upstream to downstream, as seen in the agro-food sector. Finally, they argue that the future still has to be built and that futurists produced too many scenarios and not enough projects.     

Consumption and communication perspectives of IT in a developing economy

Technological innovations are important sources of competitive advantage when there is a balanced rate of adoption that helps organisations maintain or improve performance levels. This paper synthesises and builds on efforts to conceptualise the adoption and implementation of technologically induced customer services in developing countries. Its point of departure is recent advances in computer-mediated marketing environments (CMMEs). It assesses relationships between customer services and evolving technologies in the provision of services in the banking sector. Using phenomenological hermeneutics and a case study approach, we iteratively engaged with data that emerged to identify core values and community-based values. These facets were further developed into seven main issues (core values: quality, education and reach, and community-based values: efficiency, usability, control and security). The paper offers practical steps by which companies and institutions may counter these issues and the theoretical implications for wider considerations are discussed.     

Transition economies and trust building: a network perspective on EU enlargement

Many transition economies are characterised by a relativelyrudimentary institutional framework. Weak legislative structuresand the absence of effective market regulation and propertyright enforcement rules diminish the chance of mutually profitablebusiness transactions and—more generally—restrictthe chances for innovation and sustainable growth. Against thisbackground, we analyse the extent to which more efficient governancemechanisms can contribute to a more favourable business environment.In doing so, we adopt a network perspective. We argue that bothin developed market economies as well as in centrally plannedeconomies much of economic exchange takes place in networks.However, the characteristics of these networks, in particularthe concept of trust, can differ significantly. This leads usto conclude that the real challenge of the process of economictransition is connected to building new economic exchange networks.In this paper, we discuss this argument and analyse how thecurrent enlargement of the EU into Eastern Europe may favourablyaffect this process of institutional change in the accessioncountries.