Perbandingan Model Asuhan Keperawatan Profesional Tim dengan Primary Nursing dalam Peningkatan Kualitas Asuhan Keperawatan di Rumah Sakit Kota Medan

The development of science and technology that continues to progress, especially in the health sector requires changes in terms of service so that in providing more professional services in hospitals, nursing care must be of high quality. Nursing Law Number 38 of 2014 Article 3B states that nursing arrangements aim to improve the quality of nursing services, therefore the provision of quality nursing services is important in today's health services. The model of professional nursing care is divided into several models, namely primary, team and case nursing. Based on the results of a survey of research journals, the researchers concluded that there was no research that compared the professional nursing care team model with primary nursing in improving the quality of nursing care. The purpose of this study was to identify the use of the professional nursing care team model with the primary nursing model in improving the quality of nursing care. This type of research is a quantitative research type with a comparative design. The population in this study were all patients at the Inpatient Hospital where the study was conducted. The sampling technique used was purposive sampling technique. Data collection on the quality of nursing care used a quality scale patient assessment instrument – the acute care version (PAQS-ACV). This instrument was developed to assess the quality of nursing care. Data analysis in this study used an independent t-test. normality test using the Kolmorogov-Smirnov test with a significance value (p > 0.05). The results showed that there was a significant difference between the quality of nursing care in the team group and the quality of nursing care in the primary nursing group where the value of sig (2-tailed) was 0.008 where > 0.05, the results also showed that based on the results of the frequency distribution test the quality of nursing care was using the team model and the primary nursing model has a high majority value of nursing care quality, but there is a difference in the average value (mean) where the quality of nursing care in the nursing care model group in the team method group is 144.86 and the quality of nursing care in the primary nursing model group is 155.83. These results indicate that the quality of nursing care with the primary nursing model has a higher quality of care value than the group nursing care model with the team method. Based on the results of this study, it is recommended that hospitals can apply a professional nursing practice model, especially the primary nursing model to further improve the quality of nursing care provided.

A Transitional Care Model for Veterans With Complex Needs During COVID: The Behavioral Recovery Outreach (BRO) Team

The Veterans Health Administration’s Care for Patients with Complex Problems (CP)2 Program developed a national infrastructure to disseminate promising practice models to improve care for Veterans with complex medical, mental health, and/or neurocognitive conditions, who may also have behaviors disruptive to care. A strategic priority is improving safe and effective transitions to community care for Veterans with complex care needs, many of whom have historically been limited to VA settings as a result of behavioral concerns. The Behavioral Recovery Outreach (BRO) Team was the first model identified for national dissemination and evaluation at partner sites. Developed at VA Central Iowa, BRO is an interdisciplinary team model that identifies Veterans in long-term VA care settings with complex care needs to engage in individualized behavioral programing to manage/stabilize behaviors and safely transition them to more appropriate and less costly community settings. This symposium will describe the BRO team model, highlight the facilitators and barriers to nationally disseminating the BRO model with VA partner facilities, discuss adaptations in continuing community transitions following the COVID-19 pandemic, and describe program outcomes. The first speaker will discuss development of the BRO model and outcomes of a regional dissemination. The second speaker will present results from the program evaluation of the national dissemination. The final speaker will describe BRO Team expansion and lessons learned from the perspective of a VA partner facility. The (CP)2 Program Director will integrate findings and highlight implications for scaling and evaluating promising models for national dissemination for policy, practice, and future research.

The Impact of Social Determinants of Health in Facial and Craniomaxillofacial Reconstruction: Can We Do Better?

Social determinants of health (SDOH) are integral to consider when delivering craniomaxillofacial and facial reconstructive care for patients. The American Cleft Palate-Craniofacial Association (ACPA) has instituted a formalized multidisciplinary care team model that recognizes such determinants and has aggregated patient-led organizations to strengthen patients’ education and support system. This review discusses the need for all surgeons engaged in facial and craniomaxillofacial reconstruction to consider SDOH in their practice. Additionally, we explore how factors such as race, insurance status, education level, cost, and access to follow-up care, impact surgical care for craniosynostosis, facial trauma, orthognathic surgery, head and neck cancer, and facial paralysis. We propose that the ACPA team model be applied to other societies that care for the broader scope of patients in need of facial and craniomaxillofacial reconstruction to strengthen the communication, collaboration, and standardization of care delivery that is personalized to the needs of each patient.

Simulating approaches to emergency department pandemic physician staffing during COVID-19

Objective: During pandemics, emergency departments (EDs) are challenged by the need to replace quarantined ED staff and avoid staffing EDs with nonemergency medicine (EM) trained physicians. We sought to design and examine three feasible ED staffing models intended to safely schedule EM physicians to staff three EDs within a health system during a prolonged infectious disease outbreak.Methods: We conducted simulation analyses examining the strengths and limitations of three ED clinician staffing models: two-team and three-team fixed cohort, and three-team unfixed cohort. Each model was assessed with and without immunity, and by varying infection rates. We assumed a 12-week pandemic disaster requiring a 2-week quarantine.Main outcome: The outcome, time to staffing shortage, was defined as depletion of available physicians in both 8- and 12-hour shift duration scenarios. Results: All staffing models initially showed linear physician attrition with higher infection rates resulting in faster staffing shortages. The three-team fixed cohort model without immunity was not viable beyond 11 weeks. The three-team unfixed cohort model without immunity avoided staffing shortage for the duration of the pandemic up to an infection rate of 50 percent. The two-team model without immunity also avoided staffing shortage up to 30 percent infection rate. When accounting for immunity, all models behaved similarly initially but returned to adequate staffing during week 5 of the pandemic. Conclusions: Simulation analyses reveal fundamental tradeoffs that are critical to designing feasible pandemic disaster staffing models. Emergency physicians should test similar models based on local assumptions and capacity to ensure adequate staffing preparedness for prolonged pandemics.

A Need for Updating the Research Agenda for Cleft Lip and Palate and Extending the Cleft Team Model to Dental Medicine

Care for individuals born with cleft lip and palate is done by a team approach, including dental medicine. However, oral health is not integrated in other situations that affect overall health. This perspective essay makes the case for a universal team approach, having dental medicine integrated regardless of the overall health issue, much like how cleft lip and palate is managed. Furthermore, future research agenda on the etiology of cleft lip and palate in particular will need to be adjusted for a major roadblock: the lack of more sophisticated clinical descriptions for the cases ascertained at birth.