Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle

2018 ◽  
Vol 76 (4) ◽  
pp. 359-385 ◽  
Author(s):  
L. Michele Issel
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Practice Guidelines ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Professional Expertise ◽  
Work Processes ◽  
Patient Centeredness ◽  
Medical Practitioners ◽  
Delivery Of Medical Care

The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven’s (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners’ work processes to health care organizations; this has potential benefits for organizations, clinicians/employees, and patients.

The Special Perils of Being Old and Sick in Prison

2020 ◽  
Vol 32 (5) ◽  
pp. 276-284
Author(s):  
William J. Jefferson
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
The United States ◽  
United States Constitution ◽  
Care Providers ◽  
Medical Practitioners ◽  
Medical Needs ◽  
Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

Problems in the Health Care of Dying Old Men: Complaints by their Widows

1995 ◽  
Vol 31 (2) ◽  
pp. 121-141 ◽  
Author(s):  
Maria M. Talbott
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Medical Care ◽  
Health Care Professionals ◽  
Lack Of Control ◽  
Old Men

Complaints of older widows regarding their husbands' health care are investigated in this study. Sixty-four older widows were interviewed several years after their husbands' deaths. The deaths occurred in the early 1980s. Forty-six percent reported problems in the health care their husbands had received. Widows whose husbands had not known in advance that they were going to die were more likely to complain about their husbands' medical care than widows whose husbands had known in advance. Complaints were also related to the frequency of several symptoms of grief. The widows' complaints about their husbands' care focus on quality of care, perceived insensitivity on the part of health care professionals, lack of control over the death, and the organization of services.

Telemedicine (or Teleconsultation?) Practice Guidelines of India: A Game changer or a half-hearted attempt amid COVID-19? (Preprint)

2020 ◽  
Author(s):  
Venkatesh U ◽  
Aravind Gandhi P
Keyword(s):  
Health Care ◽  
Practice Guidelines ◽  
Health Care Workers ◽  
Data Security ◽  
Patient Relationship ◽  
Medical Practitioners ◽  
Care Workers ◽  
The Government ◽  
First Time ◽  
Game Changer

UNSTRUCTURED Telemedicine is where health care intersects with Information Technology. In India, there has been no statutory regulations or official guidelines, specific for Telemedicine practice and allied matters, so far. For the first time, Government of India has released Telemedicine Practice Guidelines for Registered Medical Practitioners on March 25, 2020, amid the COVID-19 outbreak. Through this paper, we would like to initiate the discussion on the features of the guidelines, limitations, and its significance in times of COVID-19 pandemic. The guidelines are with a restricted scope for providing medical consultation to patients, excluding other aspects of Telemedicine such as research and evaluation, and the continuing education of health-care workers. The guidelines have elaborated on the eligibility for practicing Telemedicine in India, the modes and types of Teleconsultation, delved into doctor-patient relationship, consent, & management protocols, touched upon the data security & privacy aspects of the Teleconsultation. After releasing the guidelines, Telescreening of public for COVID-19 symptoms is being advocated by the Government of India. COVID-19 National Teleconsultation Centre (CoNTeC) has been initiated, which connects the doctors across the India to AIIMS in real-time for accessing expert guidance on treatment of the COVID-19 patients.

scholarly journals Bedside Nurse Acceptance of Intensive Care Unit Telemedicine Presence

2018 ◽  
Vol 38 (6) ◽  
pp. e1-e4 ◽  
Author(s):  
Christina Canfield ◽  
Sandra Galvin
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nurse Practitioners ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Perception Of Support ◽  
Evidence Based Care

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU. In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside. Despite the successes, acceptance of tele-ICU varies. Known barriers to acceptance include perceptions of intrusiveness and invasion of privacy.

Need and opportunities for professional education of nursing specialists

2021 ◽  
pp. 25-37
Author(s):  
Larisa Arkadievna Karaseva
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Professional Education ◽  
Health Care Professionals ◽  
Professional Growth ◽  
Nursing Practice ◽  
Theory Development ◽  
Management Research ◽  
Education Management ◽  
Experimental Base

The task of educating health care professionals is to create an educational and experimental base to support practice, education, management, research, and theory development in order to preserve and improve the health of the population. The article summarizes the principles of education that contribute to the professional growth of specialists, ensuring the safety and competence of medical care by improving nursing practice.

Klinkende meerstemmige verhalen, deel II

KWALON ◽  
2014 ◽  
Vol 19 (1) ◽  
Author(s):  
Monique Bussmann ◽  
Chris Kuiper ◽  
Alexander Maas
Keyword(s):  
Health Care ◽  
Labor Market ◽  
Data Collection ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Elderly Care ◽  
Music Listening ◽  
Musical Work ◽  
Narrative Methodology ◽  
The Government

Sounding polyphonic stories, part II. The phase of listening in data collection Sounding polyphonic stories, part II. The phase of listening in data collection In the Netherlands, future staffing of elderly care will demand a big effort and a lot of creativity of health care organizations and the government. In this study an unconventional qualitative, narrative methodology is applied to throw a new light on the significance having a job and working in elderly care has for health care professionals and to use this as a source of inspiration for labor market policymakers. The methodology is rather unconventional because it doesn’t only focuses on the lingual content of the stories, but also includes other significant aspects of storytelling (e.g., voice and sound). Therefore musical work forms (e.g., music listening and singing) are used additionally.In the first phase of data collection stories of care professionals about the intertwining of their lifeline and career have been collected. In the second, listening phase HR-professionals listened to the stories told by the care professionals and used them as a source of inspiration for HR policy innovation.In a former article the methodology of the storytelling phase has been described. This article treats the methodology of the listening phase in the data collection. Later on the analysis methods will be described.

Differences in Medical Care Usage between Two Mass-Gathering Sporting Events

2012 ◽  
Vol 27 (5) ◽  
pp. 458-462 ◽  
Author(s):  
James O. Burton ◽  
Stephen J. Corry ◽  
Gareth Lewis ◽  
William S. Priestman
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Professionals ◽  
Resource Planning ◽  
Level Of Care ◽  
Sporting Events ◽  
Mass Gathering ◽  
Publication Type ◽  
Sports Events ◽  
Usage Rates

AbstractBackgroundEvent planning for mass gatherings involves the utilization of methods that prospectively can predict medical resource use. However, there is growing recognition that historical data for a specific event can help to accurately forecast medical requirements. This study was designed to investigate the differences in medical usage rates between two popular mass-gathering sports events in the UK: rugby matches and horse races.MethodsA retrospective study of all attendee consultations with the on-site medical teams at the Leicester Tigers Rugby Football Club and the Leicester Racecourse from September 2008 through August 2009 was undertaken. Patient demographics, medical usage rates, level of care, as well as professional input and the effects of alcohol use were recorded.ResultsMedical usage rates were higher at the Leicester Racecourse (P < .01), although the demographics of the patients were similar and included 24% children and 16% staff. There was no difference in level of care required between the two venues with the majority of cases being minor, although a higher proportion of casualties at the Leicester Tigers event were seen by a health care professional compared with the Leicester Racecourse (P < .001). Alcohol was a contributing factor in only 5% of consultations.ConclusionsThese two major sporting venues had similar attendance requirements for medical treatment that are comparable to other mass-gathering sports events. High levels of staff and pediatric presentations may have an impact on human resource planning for events on a larger scale, and the separation of treatment areas may help to minimize the number of unnecessary or opportunistic reviews by the on-site health care professionals.BurtonJO, CorrySJ, LewisG, PriestmanWS. Differences in medical care usage between two mass-gathering sporting events. Prehosp Disaster Med.2012;27(4):1-5.

Legal and policy lessons from the Schiavo case: Is our right to choose the medical care we want seriously at risk?

2006 ◽  
Vol 4 (2) ◽  
pp. 145-153 ◽  
Author(s):  
ZITA LAZZARINI ◽  
STEPHEN ARONS ◽  
ALICE WISNIEWSKI
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Policy ◽  
Legal Status ◽  
Medical Futility ◽  
Medical Practitioners ◽  
Political Interests ◽  
Quality Of Medical Care ◽  
The Individual

The article explores the individual patient's right to refuse, withdraw, or insist on medical treatment where there is conflict over these issues involving health care personnel or institutions, family members, legal requirements, or third parties concerned with public policy or religious/ideological/political interests. Issues of physician assistance in dying and medical futility are considered. The basis and the current legal status of these rights is examined, and it is concluded that threats to the autonomy of patients, to the privacy of the doctor/patient relationship, and to the quality of medical care should be taken seriously by individuals, medical practitioners, and others concerned with developing and maintaining reasonable, effective, and ethical health care policy.

scholarly journals Liaison psychiatry or psychological medicine?

2003 ◽  
Vol 183 (1) ◽  
pp. 5-7 ◽  
Author(s):  
Geoffrey G. Lloyd ◽  
Richard A. Mayou
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Liaison Psychiatry ◽  
Hospital Patients ◽  
Psychological Medicine ◽  
Substantial Progress ◽  
Delivery Of Medical Care ◽  
The Uk ◽  
Psychiatric Profession ◽  
Behavioural Aspects

Liaison psychiatry has been recognised in many countries as a special interest or sub-speciality of psychiatry concerned with the management of general hospital patients with psychological problems. However, despite increasing awareness of the emotional and behavioural aspects of illness, it has yet to achieve substantial influence within psychiatry and, more importantly, has had only modest effects on the delivery of medical care by physicians and other specialists. Recognition of its potential by planners and commissioners has been disappointing. Regrettably, in the UK and elsewhere, recent changes in the organisation of health care could hinder its development. This paper argues that in order to make substantial progress there is a compelling need to solve a fundamental obstacle – the separation between psychiatric and general medical care. This requires:(a) convincing the psychiatric profession that consultation-liaison is a distinct sub-speciality;(b) continuing efforts by liaison psychiatrists to define their special expertise and to demonstrate that their services are effective and acceptable to medical colleagues and to patients;(c) persuading those who organise health care that liaison psychiatry services need to be provided and administered as an integral component of comprehensive medical care.

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