Hospitals have increasingly relied on nurse assistants to support nurses in the provision of patient care, yet knowledge about their contributions to the patient experience in U.S. hospitals is ...limited. We address this issue by exploring the impact of nurse assistants and registered nurses on an array of patient satisfaction measures from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. Using linked data for 2,807 hospitals from 2008 to 2016, we employ a production function approach to estimate and plot marginal impact curves for both nurse assistants and registered nurses. We find that although registered nurses are more impactful, nurse assistants are the more underdeployed staffing category. We also find that after meeting certain thresholds for minimal hours, nurse assistants have a comparative advantage in improving patient satisfaction scores in the housekeeping and patient support domain. Given their lower labor costs, further employment of nurse assistants may be warranted.
The use of personal voice-assistants like Amazon Alexa and Google Assistant has been on the rise recently. To ensure a long-term success and widespread diffusion of these products it is important to ...evaluate their continued usage scenario instead of the initial adoption intention. Majority of research evaluating the continuance usage scenario do so via an expectation-confirmation approach. However, in this work a user engagement-based approach is taken for evaluating the utilitarian and hedonic attitudes of the users towards the continued usage scenario. This is augmented with additional contextual constructs like trust, privacy risk, and satisfaction. At present, there is little empirical evidence of user engagement with voice-assistants. Moreover, the present work focuses on the continuance usage of late adopters by considering two unique personal factors (slowness of adoption and skepticism). By evaluating the engagement aspect of the laggard group, the current findings contribute to theory by providing a better understanding of how the proposed antecedents determine the continuance intention. Data is collected from 244 late adopters of voice-assistants who use these devices in their daily life for building the research framework. All the proposed hypotheses are supported except the effect of privacy risk. The implications for both theory and practice are provided based on the findings.
Physician assistants (PAs) are commonly employed in plastic surgery. However, limited data exist on their impact, which may guide decisions regarding how best to integrate them into practice.
A ...review of the practices of 2 breast reconstructive surgeons was performed. A comparison was made between a 1-year period before to a 1-year period after the addition of a PA into practice. The practice model was a one-to-one pairing of a plastic surgeon and a PA.
A total of 4141 clinic encounters and 1356 surgical cases were reviewed. After the addition of PAs, there was a significant increase in relative value units (1057 vs 1323 per month per surgeon, P < 0.001). Operative times were similar with and without PAs (P = 0.45). However, clinic encounter times for surgeons were shorter for all visit types when patients were first seen by a PA before the surgeon: global follow-up (P = 0.03), other follow-up (P = 0.002), consultation (P = 0.76), and preoperative (P = 0.02), translating to 9 additional patients seen per day. Charges (P = 0.001) and payments (P = 0.007) also increased, which offset the cost of using a PA. However, the financial contribution from PA involvement as first assistant in surgery was limited (5.2%). The peak effect of PAs was observed between the third and fourth quarters.
In breast reconstruction, PAs primarily enhance the efficiency of plastic surgeons, particularly in the clinic, with downstream clinical and financial gains of an indirect nature for surgeons.
This paper describes five orientations informing the efforts of postsecondary educators to teach more accessibly, including commitments to accessibility as the mandated, right, pedagogically ...effective, nice, and/or profitable thing to do. These orientations emerged from focus groups and interviews with instructors and teaching assistants at a research-intensive Canadian university. By attending to these underlying orientations, we can grapple with important, but often unexamined, complexities, such as messages we may be inadvertently endorsing and contradictions between intentions and potential outcomes and their ramifications. We encourage support for educators to reflect on the limitations and complications of their orientations and associated efforts to advance accessibility, as well as cross-pollination with other areas of critical scholarship beyond that focusing on Universal Design and accessibility-specific principles.
Points of interest
University instructors and teaching assistants seek to teach more accessibly for a number of reasons.
This paper describes five reasons - or 'orientations' - for teaching more accessibly informed by: (1) legislative or university requirements; (2) equity and social justice; (3) effective teaching practices; (4) kindness; and/or (5) profit.
Paying attention to these orientations for teaching more accessibly is important because they may impact which accessibility practices are implemented, when and under what conditions, and for whose benefit.
Some orientations may also promote negative ideas of disability, such as disability as costly or a burden, even while they encourage teaching more accessibly.
We reflect on the challenges and limitations of applying 'accessibility' language and principles broadly to 'all' students, instead of intentionally focusing on reducing barriers for students with disabilities.
With the growth of vertical integration among physician practices (i.e., hospital–physician integration), there have been many studies of its effects on health care treatments and spending. It is ...unknown if integration shapes provider configurations, especially against the backdrop of increasing employment of nurse practitioners (NPs) and physician assistants (PAs) across specialties. Using a longitudinal panel of 144,289 practices (2008-2015), we examined the association of vertical integration with NP and PA employment. We find positive associations between vertical integration and newly employing NPs and PAs within physician practices; however, the relationships differ by practice specialty type as well as timing of vertical integration. Supplementary analyses offer supporting evidence for coinciding enhancements to practice productivity, diversification, and provider task allocation. Our results suggest that vertical integration may promote interdisciplinary provider configurations, which has the potential to improve care delivery efficiency.
Virtual assistants (VAs), like Amazon’s Alexa, Google’s Assistant, and Apple’s Siri, are on the rise. However, despite allegedly being ‘assistants’ to users, they ultimately help firms to maximise ...profits. With more and more tasks and leeway bestowed upon VAs, the severity as well as the extent of conflicts of interest between firms and users increase. This article builds on the common law field of fiduciary law to argue why and how regulators should address this phenomenon. First, the functions of VAs resemble established fiduciaries, namely mandataries when they perform tasks on behalf of users, and increasingly advisors whenever they provide recommendations or suggestions. Second, users grant firms deploying VAs ever more discretion over their economic, and more and more significant non-economic interests, such as their health or finances. This delegation of power renders users vulnerable to abuse of power and inadequate performance by firms deploying VAs. Moreover, neither specification or monitoring nor market forces are alternatives that can sufficiently protect users. Thus, regulation is needed, departing from the recognition of the relationship between firms deploying VAs and users as a fiduciary relationship. In the EU, this could be realised through fiduciary requirements for VAs. First and foremost, to adequately protect users from abuse of power by firms deploying VAs, the core fiduciary duty of loyalty should be converted into corresponding fiduciary requirements for VAs, obliging firms to align VAs with their users.
•CNAs are interested in incorporating creativity within practice•It is feasible to implement creative caregiving within long term care•Creativity has the potential of enhancing CNA empowerment and ...job satisfaction
Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) was developed to train certified nursing assistants (CNAs) to apply arts-based techniques to enhance care and support to older adults in long-term care (LTC) settings. We piloted (n=8) KNACC techniques for use in LTC and assessed its potential for influence on the CNA outcomes of structural empowerment and job satisfaction. During preliminary implementation, CNAs working in memory care units were more open to applying all techniques. The techniques in KNACC have the potential to improve CNA skills in working with long-term care residents.
This article addresses aspects of the relationship between disabled people and their personal assistants within the user‐controlled personal assistance programme in Norway (BPA — brukerstyrt ...personlig assistanse). Within this programme, a disabled person and her/his personal assistant (PA) form a working relationship in which the disabled person functions as a supervisor for her/his PA. The purpose of the programme is to enable the supervisor to live as independently as possible, equal to any other member of society. In a study conducted about the work relationship between physically disabled persons and their PAs, we found that many supervisors wanted service, not care, from their PAs. Furthermore, the supervisors’ image of the ideal PA was one who was invisible. In this article, we wish to address the tensions between supervisors’ hard‐won rights to personal assistance in order to live independent lives and the gendered work‐related implications of positioning PAs as invisible service workers within this work relationship.
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