Managing Outcomes through Collaborative Care

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JANUARY 1996, VOL 63, NO 1 Subjects who reported experi- ences with specific treatments did not respond differently to the vignettes than those who had not reported previous experiences. The majority of patients (ie, 67%) and surrogates (ie, 56%) selected a patients chance of recovery as the most important factor in making decisions about life-sustaining treatments. The patients also selected potential for self-care, probable time left to live, and burden on family mem- bers as factors that would influ- ence their decisions. The surro- gates selected pain, probable time left to live, and a patients mental abilities as factors that would influence their decision making. None of the surrogates selected burden on family members as being an important factor in deci- sion making. The investigators noted some interesting discrepancies in what members of the patient-surrogate pairs reported. Seventy-three per- cent of the patients reported hav- ing discussed their preferences about life-sustaining treatment with their surrogates or other fam- ily members or friends; however, only 60% of the surrogates report- ed having had these discussions with the patients. Six patients reported having living wills, whereas nine of the surrogates reported that the patients had liv- ing wills. Three surrogates stated that patients had executed durable powers of attorney, but no patients reported having taken this action. The investigators selected a fairly rigorous significance level (P < .01). They did not state their reasoning for this decision. Per- haps the critical nature of the deci- sions made by patients and surro- gates was the impetus for this rig- orous level. Perioperative nursing Implica- tions. Most perioperative nurses deal with life-and-death situations during their careers, and many perioperative nurses face these sit- uations daily. Perioperative nurses may be reassured by the fact that the investigators in this study dis- covered no significant differences between patients and surrogates choices except in the case of pal- liative chemotherapy. The discrepancy between patients and surrogates reports of previous discussions about prefer- ences for life-sustaining treat- ments, existence of living wills, and executions of durable powers of attorney may be disconcerting for perioperative nurses. Treat- ment time may be delayed, or members of the health care team may need to make crucial choices while these issues are being resolved. Perioperative nurses must con- sider the significance of the surro- gates uncertainty about ventilator treatment and CPR for patients. As health care providers, we usually have been educated to take actions to preserve life. In emergent situa- tions, we may fail to consider that CPR can be viewed as assaults on patients rather than a method of saving lives. The study results also have personal significance for periop- erative nurses. We can become patients or surrogates in a few seconds. We need to discuss with our family members the choices we want made for us in the event we cannot make these decisions for ourselves. We also need to ask what choices they would want us to make for them. ANITA JO SHOUP RN, MSN, CNOR NURSING RESEARCH COMMIITEE CHAIR BOOK REVIEWS MANAGING OUTCOMES THROUGH COLLABORA TlVE CARE Edited by Karen Zunder 1995,224 pp $49.95 AHA members, $59.95 nonmembers, paperback c patients and their family members positive outcomes. Achieving collaborative care in todays health care system can be accomplished by coordinating the contributions of caregivers from a variety of health care disciplines. The complex phenomenon is being developed through the use of case management models, con- tinuous quality improvement processes, and critical pathways for diagnosis related groups. This book discusses care maps, in which both the science and art of nursing and medicine are com- bined to produce positive clinical outcomes. The care map tool is a collaborative process involving consensus building, negotiation, and review of theoretical data to produce clinical outcomes that are positive and cost-effective. In gen- eral, surgical procedure categories are more likely to follow a stan- dard critical pathway than are medical treatment categories. This book is a valuable resource for organizations that are developing strategies to imple- ment interdisciplinary collabora- tive care that focuses on positive outcomes. Care maps are empha- sized as tools to bridge the art, sci- ence, and business of health care. Strategies to develop, implement, and evaluate care maps in an orga- nization are delineated clearly. The editor is a pioneer in the development of care maps. The ollaborative care is defmed as a mechanism for achieving 287 AORN JOURNAL JANUARY 1996, VOL 63, NO 1 contributing authors have exper- tise in building collaborative care relationships in health care organi- zations to improve the coordina- tion of care among the various health care disciplines to produce positive outcomes. The tools and grids provided in the book can be used as guidelines to customize a care map for a specific organiza- tion. The book follows a logical sequence from the historical development and refinement of the development of care maps to strategies for implementation and evaluation. This book is available from American Hospital Publishing, Inc, through AHA Services, Inc, PO Box 92683, Chicago, IL 60675-2683; (800) 242-2626. JANE E. KUHN RN, MSN, CNOR ADMINISTRATIVE SUPERVISOR ST LUKES HOSPITAL SAN FRANCISCO A DVA NClNG KINGS SYSTEMS FRAMEWORK AND THEORY OF NURSING Edited by Maureen A . Frey, Christina L. Sieloff 1995,272 pp $22.95 paperback T goal attainment and the con- ceptual framework applied to dif- ferent concepts in nursing practice by Imogene King, RN, EdD, FAAN. The editors are to be com- plimented on providing diverse applications of Dr Kings frame- work and research-based findings from various credentialed and knowledgeable nursing authors around the country, including one from Sweden and one from Japan. Knowledge of Dr Kings theo- ry of goal attainment and concep- his book is a compilation and explication of the theory of tual framework is evident in each authors contribution. It was sur- prising to find that all areas of nursing, including college nursing programs, hospital management systems, nursing diagnoses, psy- chiatric nursing, pediatric nursing, and perioperative settings, use Dr Kings framework and/or theory. The concepts of empathy, power, space, and sorrow are explored and developed using Dr Kings conceptual framework and three interacting systems. The chapter content ranges from the application of Dr Kings framework and nursing diagnoses to an esoteric discussion of Dr Kings view of health, which was somewhat difficult to understand. This chapter is first, which might deter readers from reading further chapters. The book requires advanced knowledge of and famil- iarity with the four components of the nursing metaparadigm, along with the ability to distinguish between abstract conceptual mod- els and concrete theory. The tables and figures are appropriate and support the con- tent. Research results range from easily read tables to advanced sta- tistics that require additional thought. The books content is organized into two parts: the con- ceptual framework and the theory of goal attainment. A summary is presented at the end of each chap- ter, and further ideas for nursing research are presented by many of the authors. Dr Kings theory and conceptu- al framework are discussed in the beginning of the book. The reader is not required to jump into a full discussion of the theory and con- ceptual framework; rather, the book presents a thorough explana- tion so that the reader easily under- stands the discussion. This book contains a wealth of information and ideas for applica- tion by graduate nursing students or for health care personnel who are contemplating a conceptual framework for their institution. It is an invaluable reference for a new perspective on nursing diag- noses, management, and patient care. Perioperative nurses are in a prime position to use this concep- tual framework with patients. This book is available from Sage Publications, Inc, 2455 Teller Rd, Thousand Oaks, CA 9 1320 (805) 499-072 1. CYNTHIA C. ELLIS-STOLL RN, MSN, ARNP PERIOPERATIVE CLINICAL NURSE SPECIALIST ST JOSEPH MEDICAL CENTER WICHITA, KAN FOCUS CHARTING: CENTERED CARE, sixth ed By Susan Lampe 1 9 9 4 , 2 8 3 ~ ~ $25 paperback ince becoming an RN first assistant, I have found that s many nurses are disorganized when charting or developing care plans-they hate even the thought of putting a care plan together. This book can help make the process easier. Unfortunately, peo- ple tend to resist change, even when they see that change might make a process better. Focus charting is computer friendly, can be used within the framework of charting by excep- tion and critical pathways, and has decreased charting time, which yields cost savings. These are fac- tors to consider if and when an institution wants to change its charting system. All hospital health care workers (eg, float nurs- es, social workers, physicians, DOCUMENTATION FOR PATIENT- 288 AORN JOURNAL


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