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The Complexities of Care

by Sioban Nelson Suzanne Gordon

Nursing, everyone believes, is the caring profession. Texts on caring line the walls of nursing schools and student shelves. Indeed, the discipline of nursing is often known as the 'caring science. ' Because of their caring reputation, nurses top the polls as the most-trustworthy professionals. Yet, in spite of what seems to be an endless outpouring of public support, in almost every country in the world nursing is under threat, in the practice setting and in the academic sector. Indeed, its standing as a regulated profession is constantly challenged. In our view, this paradox is neither accidental nor natural but, in great part, the logical consequence of the fact that nurses and their organizations place such a heavy emphasis on nursing's and nurses' virtues rather than on their knowledge and concrete contributions. -from the Introduction In a series of provocative essays, The Complexities of Care rejects the assumption that nursing work is primarily emotional and relational. The contributors-international experts on nursing- all argue that caring discourse in nursing is a dangerous oversimplification that has in fact created many dilemmas within the profession and in the health care system. This book offers a long-overdue exploration of care at a pivotal moment in the history of health care. The ideas presented here will foster a critical debate that will assist nurses to better understand the nature and meaning of the nurse-patient relationship, confront challenges to their work and their profession, and deliver the services patients need now and into the future.

First, Do Less Harm

by Ross Koppel Suzanne Gordon

Each year, hospital-acquired infections, prescribing and treatment errors, lost documents and test reports, communication failures, and other problems have caused thousands of deaths in the United States, added millions of days to patients' hospital stays, and cost Americans tens of billions of dollars. Despite (and sometimes because of) new medical information technology and numerous well-intentioned initiatives to address these problems, threats to patient safety remain, and in some areas are on the rise. In First, Do Less Harm, twelve health care professionals and researchers plus two former patients look at patient safety from a variety of perspectives, finding many of the proposed solutions to be inadequate or impractical. Several contributors to this book attribute the failure to confront patient safety concerns to the influence of the "market model" on medicine and emphasize the need for hospital-wide teamwork and greater involvement from frontline workers (from janitors and aides to nurses and physicians) in planning, implementing, and evaluating effective safety initiatives. Several chapters in First, Do Less Harm focus on the critical role of interprofessional and occupational practice in patient safety. Rather than focusing on the usual suspects-physicians, safety champions, or high level management-these chapters expand the list of "stakeholders" and patient safety advocates to include nurses, patient care assistants, and other staff, as well as the health care unions that may represent them. First, Do Less Harm also highlights workplace issues that negatively affect safety: including sleeplessness, excessive workloads, outsourcing of hospital cleaning, and lack of teamwork between physicians and other health care staff. In two chapters, experts explain why the promise of health care information technology to fix safety problems remains unrealized, with examples that are at once humorous and frightening. A book that will be required reading for physicians, nurses, hospital administrators, public health officers, quality and risk managers, healthcare educators, economists, and policymakers, First, Do Less Harm concludes with a list of twenty-seven paradoxes and challenges facing everyone interested in making care safe for both patients and those who care for them.

Life Support

by Suzanne Gordon

A beautiful, profound, and profoundly important book. . . . Gordon's message is simplicity itself: sick people need skilled, humane, and insightful care that keeps their interests paramount. Registered nurses have historically provided that care, but now their ability to fulfill their crucial role faces the greatest jeopardy in the history of the profession. . . . Life Support belongs in the august company of Silent Spring, The Other America, The Feminine Mystique, and other pivotal works with the power to shape the nation's consciousness. -Washington Post "In this enlightening, involving, in-depth book, Gordon interweaves the history and philosophy of nursing with on-the-job observations of three nurses at Boston's Beth Israel Hospital. Gordon lets the nurses speak for themselves, effectively illustrating their commitment to their profession and involving readers in real-life dramas. "-Publishers Weekly "For patients, physicians, nurses, and health policy analysts, Gordon's passionate and accessible account of the impact of managed care on skilled nursing provides clear grounds for concern. "-Health Affairs In this book, Suzanne Gordon describes the everyday work of three RNs in Boston-a nurse practitioner, an oncology nurse, and a clinical nurse specialist on a medical unit. At a time when nursing is often undervalued and nurses themselves in short supply, Life Support provides a vivid, engaging, and intimate portrait of health care's largest profession and the important role it plays in patients' lives. Life Support is essential reading for working nurses, nursing students, and anyone considering a career in nursing as well as for physicians and health policy makers seeking a better understanding of what nurses do and why we need them. For the Cornell edition of this landmark work, Gordon has written a new introduction that describes the current nursing crisis and its impact on bedside nurses like those she profiled in the book.

Nursing Against The Odds

by Suzanne Gordon

In the United States and throughout the industrialized world, just as the population of older and sicker patients is about to explode, we have a major shortage of nurses. Why are so many RNs dropping out of health care's largest profession? How will the lack of skilled, experienced caregivers affect patients? These are some of the questions addressed by Suzanne Gordon's definitive account of the world's nursing crisis. In Nursing against the Odds, one of North America's leading health care journalists draws on in-depth interviews, research studies, and extensive firsthand reporting to help readers better understand the myriad causes of and possible solutions to the current crisis. Gordon examines how health care cost cutting and hospital restructuring undermine the working conditions necessary for quality care. She shows how the historically troubled workplace relationships between RNs and physicians become even more dysfunctional in modern hospitals. In Gordon's view, the public image of nurses continues to suffer from negative media stereotyping in medical shows on television and from shoddy press coverage of the important role RNs play in the delivery of health care. Gordon also identifies the class and status divisions within the profession that hinder a much-needed defense of bedside nursing. She explains why some policy panaceas-hiring more temporary workers, importing RNs from less-developed countries-fail to address the forces that drive nurses out of their workplaces. To promote better care, Gordon calls for a broad agenda that includes safer staffing, improved scheduling, and other policy changes that would give nurses a greater voice at work. She explores how doctors and nurses can collaborate more effectively and what medical and nursing education must do to foster such cooperation. Finally, Gordon outlines ways in which RNs can successfully take their case to the public while campaigning for health care system reform that actually funds necessary nursing care.

Safety in Numbers

by Suzanne Gordon John Buchanan Tanya Bretherton

Legally mandated nurse-to-patient ratios are one of the most controversial topics in health care today. Ratio advocates believe that minimum staffing levels are essential for quality care, better working conditions, and higher rates of RN recruitment and retention that would alleviate the current global nursing shortage. Opponents claim that ratios will unfairly burden hospital budgets, while reducing management flexibility in addressing patient needs. Safety in Numbers is the first book to examine the arguments for and against ratios. Utilizing survey data, interviews, and other original research, Suzanne Gordon, John Buchanan, and Tanya Bretherton weigh the cost, benefits, and effectiveness of ratios in California and the state of Victoria in Australia, the two places where RN staffing levels have been mandated the longest. They show how hospital cost cutting and layoffs in the 1990s created larger workloads and deteriorating conditions for both nurses and their patients-leading nursing organizations to embrace staffing level regulation. The authors provide an in-depth account of the difficult but ultimately successful campaigns waged by nurses and their allies to win mandated ratios. Safety in Numbers then reports on how nurses, hospital administrators, and health care policymakers handled ratio implementation. With at least fourteen states in the United States and several other countries now considering staffing level regulation, this balanced assessment of the impact of ratios on patient outcomes and RN job performance and satisfaction could not be timelier. The authors' history and analysis of the nurse-to-patient ratios debate will be welcomed as an invaluable guide for patient advocates, nurses, health care managers, public officials, and anyone else concerned about the quality of patient care in the United States and the world.

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