Nursing in a Transformed Health Care System: New Roles, New Rules

Although the supply of nurses is likely to meet overall demand, the nature of a nurse’s job is changing dramatically. In redesigned health care systems, nurses are assuming expanded roles for a broad range of patients in ambulatory settings and communitybased care. These roles involve new responsibilities for population health, care coordination and interprofessional collaboration. Nursing education needs to impart new skills and regulatory frameworks need to be updated to optimize the contributions of nurses in transformed care delivery models

An introduction to video methods in organizational research

Video has become a methodological tool of choice for many researchers in social science, but video methods are relatively new to the field of organization studies. This article is an introduction to video methods. First, we situate video methods relative to other kinds of research, suggesting that video recordings and analyses can be used to replace or supplement other approaches, not only observational studies but also retrospective methods such as interviews and surveys. Second, we describe and discuss various features of video data in relation to ontological assumptions that researchers may bring to their research design. Video involves both opportunities and pitfalls for researchers, who ought to use video methods in ways that are consistent with their assumptions about the world and human activity. Third, we take a critical look at video methods by reporting progress that has been made while acknowledging gaps and work that remains to be done. Our critical considerations point repeatedly at articles in this special issue, which represent recent and important advances in video method

Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital Readmission

Objectives To determine whether receipt of therapy and number and timing of therapy visits decreased hospital readmission risk in stroke survivors discharged home. Design Retrospective cohort analysis of Medicare claims (2010–2013). Setting Acute care hospital and community. Participants Patients hospitalized for stroke who were discharged home and survived the first 30 days (N=23,413; mean age ± SD, 77.6±7.5y). Interventions Physical and occupational therapist use in the home and/or outpatient setting in the first 30 days after discharge (any use, number of visits, and days to first visit). Main Outcome Measures Hospital readmission 30 to 60 days after discharge. Covariates included demographic characteristics, proxy variables for functional status, hospitalization characteristics, comorbidities, and prior health care use. Multivariate logistic regression analyses were conducted to examine the relation between therapist use and readmission. Results During the first 30 days after discharge, 31% of patients saw a therapist in the home, 11% saw a therapist in an outpatient setting, and 59% did not see a therapist. Relative to patients who had no therapist contact, those who saw an outpatient therapist were less likely to be readmitted to the hospital (odds ratio, 0.73; 95% confidence interval, 0.59–0.90). Although the point estimates did not reach statistical significance, there was some suggestion that the greater the number of therapist visits in the home and the sooner the visits started, the lower the risk of hospital readmission. Conclusions After controlling for observable demographic-, clinical-, and health-related differences, we found that individuals who received outpatient therapy in the first 30 days after discharge home after stroke were less likely to be readmitted to the hospital in the subsequent 30 days, relative to those who received no therapy

Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care

Objective: To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke. Design: Retrospective cohort analysis of Medicare claims (2010–2013) linked to hospital-level and county-level data. Setting: Acute care hospital and community. Participants: Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke. Interventions: Not applicable. Main Outcome Measures: Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics. Results: Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use. Conclusions: Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use

COVID-19 and the Health Workforce

The health workforce has been greatly affected by COVID-19. In this commentary, we describe the articles included in this health workforce research supplement and how the issues raised by the authors relate to the COVID-19 pandemic and rapidly changing health care environment

Ensuring and sustaining a pandemic workforce

Current efforts to fight the Covid-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members. It seems clear that health care delivery organizations, educators, and government leaders will all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand the U.S. health care workforce and sustain it for the duration of the pandemic

Three dimensional electron microscopy reveals changing axonal and myelin morphology along normal and partially injured optic nerves

Following injury to the central nervous system, axons and myelin distinct from the initial injury site undergo changes associated with compromised function. Quantifying such changes is important to understanding the pathophysiology of neurotrauma; however, most studies to date used 2 dimensional (D) electron microscopy to analyse single sections, thereby failing to capture changes along individual axons. We used serial block face scanning electron microscopy (SBF SEM) to undertake 3D reconstruction of axons and myelin, analysing optic nerves from normal uninjured female rats and following partial optic nerve transection. Measures of axon and myelin dimensions were generated by examining 2D images at 5 µm intervals along the 100 µm segments. In both normal and injured animals, changes in axonal diameter, myelin thickness, fiber diameter, G-ratio and percentage myelin decompaction were apparent along the lengths of axons to varying degrees. The range of values for axon diameter along individual reconstructed axons in 3D was similar to the range from 2D datasets, encompassing reported variation in axonal diameter attributed to retinal ganglion cell diversity. 3D electron microscopy analyses have provided the means to demonstrate substantial variability in ultrastructure along the length of individual axons and to improve understanding of the pathophysiology of neurotrauma

Mindfulness in Action: Discovering How U.S. Navy Seals Build Capacity for Mindfulness in High-Reliability Organizations (HROs)

This study of US Navy Sea Air and Land (SEAL) commandos contributes to research investigating mindfulness in High-Reliability Organizations (HROs) by identifying the individual and collective influences that allow SEALs to build capacity for mindful behaviors despite the complexity of their missions, the unpredictability of their operating environments, and the danger inherent in their work. Although the HRO literature identifies a number of hallmarks of reliability, less attention is paid to how mindfulness is operationally achieved in situ by individuals on the frontline working in HROs. This study addresses this gap using a multi-phase, multi-method investigation of US Navy SEALs, identifying new links between individual mindfulness attributes (comfort with uncertainty and chaos) and collective mindfulness influences (a positive orientation towards failure) that combine to co-create a phenomenon we call 'mindfulness in action'. Mindfulness in action occurs when HROs achieve an attentive yet flexible focus capable of incorporating multiple—sometimes competing—realities in order to assess alternative solutions and take action in dynamic situations. By providing a more nuanced conceptualization of the links between individual mindfulness attributes and collective mindfulness influences, this paper opens up new avenues of discovery for a wide range of reliability-seeking organizations.This study of US Navy Sea Air and Land (SEAL) commandos contributes to research investigating mindfulness in High-Reliability Organizations (HROs) by identifying the individual and collective influences that allow SEALs to build capacity for mindful behaviors despite the complexity of their missions, the unpredictability of their operating environments, and the danger inherent in their work. Although the HRO literature identifies a number of hallmarks of reliability, less attention is paid to how mindfulness is operationally achieved in situ by individuals on the frontline working in HROs. This study addresses this gap using a multi-phase, multi-method investigation of US Navy SEALs, identifying new links between individual mindfulness attributes (comfort with uncertainty and chaos) and collective mindfulness influences (a positive orientation towards failure) that combine to co-create a phenomenon we call 'mindfulness in action'. Mindfulness in action occurs when HROs achieve an attentive yet flexible focus capable of incorporating multiple—sometimes competing—realities in order to assess alternative solutions and take action in dynamic situations. By providing a more nuanced conceptualization of the links between individual mindfulness attributes and collective mindfulness influences, this paper opens up new avenues of discovery for a wide range of reliability-seeking organizations

A community of practice or a working psychological group? Group dynamics in core and peripheral community participation

The concept of communities of practice (CoP) has become increasingly influential in management literature. Yet, many scholars regard the term as too homogenous and lacking in empirical support. Our study explores the Silver Academy, a project involving over 100 unemployed and self-employed managers over the age of 50, who came together with the purpose of sharing knowledge and experience in starting up their own businesses. The study shows how the Academy matches the notion of CoP including mutual relationships, shared engagement and a common consensus of membership. However, applying Bion’s (1961) theory of groups, we challenge the homogenous and consensual notion of a community of practice, illustrating how, through unconscious group processes, some group members exhibit workgroup mentality and the capacity for realistic hard work (and leadership), while others are caught in a basic-assumption mentality, prone to feelings of anxiety, guilt and depression. This is particularly so for a group that has gone through the recent trauma of unemployment