Papers by Madeline Schmitt
Nursing Science Quarterly, 2003
IISE Transactions, 2017
Due to the aging of our society, patient care needs to be well coordinated within the health care... more Due to the aging of our society, patient care needs to be well coordinated within the health care team in order to effectively manage the overall health of each patient. Staff nurses, as the patient's "ever-present" health care team members, play a vital role in the care coordination. The recently developed Nurse Care Coordination Instrument (NCCI) is the first of its kind that enables quantitative data to be collected to measure various aspects of nurse care coordination. Driven by this new development, we propose a multiresponse multilevel model with joint fixed effect selection and joint random effect selection across multiple responses. This model is particularly suitable for modeling the unique data structure of the NCCI due to its ability of jointly modeling of multilevel predictors, including demographic and workload variables at the individual/nurse level and characteristics of the practice environment at the unit level and multiple response variables that measure the key components of nurse care coordination. We develop a Block Coordinate Descent algorithm integrated with an Expectation-Maximization framework for model estimation. Asymptotic properties are derived. Finally, we present an application to a data set collected across four U.S. hospitals using the NCCI and discuss implications of the findings.
Research in Nursing & Health
Nursing Outlook, 2012
In an earlier editorial, Dr. Virginia Tilden wrote about Building on the Core Competencies the na... more In an earlier editorial, Dr. Virginia Tilden wrote about Building on the Core Competencies the national momentum toward interprofessional education (IPE) and the “tides of change” that have rapidly increased opportunities for nurse leaders to shape this agenda. The common goal of improving patient care through IPE has forged a high level of collaboration among education and practice leaders, potential funders and government. This subsequent editorial updates developments in IPE and calls for transformative IPE curricula that will signal a true tide of change.
Journal of Pain and Symptom Management, 2011
Context-Despite rapid proliferation of hospital-based palliative care consultation services (PCCS... more Context-Despite rapid proliferation of hospital-based palliative care consultation services (PCCS) across the country, there is little description of the dynamic processes that the PCCS and the non-PCCS hospital cultures experience during the institutionalization of a successful PCCS. Objectives-To describe the institutionalization of a new PCCS in a quaternary care academic medical center (AMC) and highlight two themes, cost and quality, that pervaded the dynamics involved from the inception to the successful integration of the service. Methods-Ethnography using longitudinal field observations, in-depth interviews, and the collection of artifacts. The study was performed in a 750-bed quaternary care ACM in the northeastern region of the U.S. Participants were a purposefully selected sample (n = 79) of (a) senior-level institutional administrators, including clinical leaders in nursing, medicine, and social work, (b) clinicians who used the PCCS, either commonly or rarely, and (c) members of the PCCS core and extended teams. Results-Key infrastructure components that contributed to the successful integration of the PCCS included: top level interprofessional administrative buy-in to the quality and cost arguments for PCCS, PCCS leadership selection, robust data collection strategies emphasizing quality outcome data, the adoption of the "physician referral only" rule, and incremental and sustainable growth. The PCCS service has grown an average of 23% per year from 2003-2009. Conclusion-An in-depth understanding of the dynamic interaction of the infrastructures and processes of a successful institutionalization, in their unique complexity, may help other PCCSs identify and negotiate attributes of their own circumstances that will increase their chances for successful and sustainable implementation.
Journal of Interprofessional Care, 2007
to the field of interprofessional education and practice (IPEP). The idea for this supplement ori... more to the field of interprofessional education and practice (IPEP). The idea for this supplement originated with Hugh Barr, Joint Editor-in-Chief of the Journal, an indication of the reach of Dr Baldwin's work beyond the limits of the USA, where he has spent his career. Hugh worked with Lynda D'Avray to complete the wide-ranging oral history interview with Dr Baldwin that begins the issue and provides context for the selection of Dr Baldwin's papers included in the issue. Together, we have worked with Dr Baldwin to select those papers, and I have provided oversight and implementation for the republication process. DeWitt C. Baldwin Jr. is one of the pioneers of and, most certainly, the most long-time advocate for interprofessionalism in health care in the USA. His efforts in the field span his entire professional and post-retirement career, as well as the contemporary history of IPEP in the USA. He counts among his colleagues many, if not most of, the other early leaders in the field, including Drs Edmund Pellegrino, and David Kindig in the USA, Dr Jack McCreary of Canada, Dr John Horder of the UK, and Dr Bill Piggot of Australia. One of his closest professional colleagues in his early work was Michele Baldwin, a social worker and therapist, who is his wife. Currently a Scholar-in-Residence at the Accreditation Council for Graduate Medical Education in Chicago, Illinois, he continues to be very busy with research, writing, and presentations in medical and interprofessional education, as well as collaborative and relationship centered health care. ''Bud'', as he is affectionately known among his colleagues and friends, celebrated his 85th birthday this past summer. My own relationship with Bud began at the 3rd Annual Interdisciplinary Health Care Team Conference (IHCTC) held in Kalamazoo, Michigan in September of 1981. Dr Baldwin and his colleagues had initiated the first two conferences, emerging from their work in IPEP for primary care. The conference in Kalamazoo marked an expansion of its focus beyond primary care. With oversight from a ''Steering Committee'' these annual meetings continued at various locations for 23 years, the last two held in conjunction with the annual meeting of the National Academies of Practice. It was the forum for interprofessional discussions among educators, clinicians, and researchers across disciplines and health professions in the USA, at a time when there was little widespread interest in IPEP. Bud was, in some years, the only physician in attendance. In the late 1970s four of us at the University of Rochester School of Nursing created an informal group to provide support to each other in our interprofessional clinical and research efforts. My three colleagues were all primary-care focused, whereas my
Critical Care Medicine, 1999
To investigate the association of collaboration between intensive care unit (ICU) physicians and ... more To investigate the association of collaboration between intensive care unit (ICU) physicians and nurses and patient outcome. Prospective, descriptive, correlational study using self-report instruments. A community teaching hospital medical ICU, a university teaching hospital surgical ICU, and a community non-teaching hospital mixed ICU, all in upstate New York. Ninety-seven attending physicians, 63 resident physicians, and 162 staff nurses. When patients were ready for transfer from the ICU to an area of less intensive care, questionnaires were used to assess care providers' reports of collaboration in making the transfer decision. After controlling for severity of illness, the association between interprofessional collaboration and patient outcome was assessed. Unit-level organizational collaboration and patient outcomes were ranked. Healthcare providers' reported levels of collaboration, patient severity of illness and individual risk, patient outcomes of death or readmission to the ICU, unit-level collaboration, and unit patient risk of negative outcome. Medical ICU nurses' reports of collaboration were associated positively with patient outcomes. No other associations between individual reports of collaboration and patient outcome were found. There was a perfect rank order correlation between unit-level organizational collaboration and patient outcomes across the three units. The study offered some support for the importance of physician-nurse collaboration in ICU care delivery, a variable susceptible to intervention and further study.
AJN, American Journal of Nursing, 1968
ABSTRACT
American Journal of Critical Care, 2011
Background To support the process of effective family decision making, it is important to recogni... more Background To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process. Objective To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units. Methods Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit. Participants Health care clinicians, patients, and family members. Results Informal roles for family members consistently observed were primary caregiver, primary decision maker, family spokesperson, out-of-towner, patient’s wishes expert, protector, vulnerable member, and health care e...
Journal of Critical Care, 2007
Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (... more Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time, to evaluate similarities and differences in the cultural contexts of four ICUs and the relationship of those contexts to EOLDM. Materials and Methods: Ethnographic field work took place in four adult ICUs in a tertiary care hospital. Participants were health care providers (e.g., physicians, nurses, and social workers), patients and their family members. Participant observation and interviews took place 5 days/week for 7 months in each unit. Results: The ICUs were not monolithic. There were similarities, but important differences in EOLDM were identified in formal and informal rules, meaning and uses of technology, physician roles and relationships, processes such as unit rounds, and timing of initiation of EOLDM. Conclusions: As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful.
Palliative Medicine, 2002
Gerontologist, 1988
Page 1. Copyright 1988 by The Cerontological Society of America Despite the frequent claims of th... more Page 1. Copyright 1988 by The Cerontological Society of America Despite the frequent claims of the superiority of interdisciplinary teams over more usual care patterns, systematic studies of the effectiveness of geriatric interdisciplinary teams are rare. ...
Http Dx Doi Org 10 1080 17496535 2011 546181, Mar 1, 2011
... 200913. Liaskos, J., Firgas, A., Konstantinos, A. and Dimitrios, Z. 2009. ... Liaskos, J., Fi... more ... 200913. Liaskos, J., Firgas, A., Konstantinos, A. and Dimitrios, Z. 2009. ... Liaskos, J., Firgas, A., Konstantinos, A. and Dimitrios, Z. 2009. Promoting Interprofessional Education in Health Sector within the European Interprofessional Education Network. ...
Http Dx Doi Org 10 1080 0360127940200106, Jul 9, 2006
ABSTRACT
Sociology and Social Research, 1972
Adolescence
This paper has described the groups for pregnant teenagers developed in the Rochester Adolescent ... more This paper has described the groups for pregnant teenagers developed in the Rochester Adolescent Maternity Project. One and one-half year's experience with these groups has allowed the authors time to begin their study of groups and to write a descriptive paper of their evolution. The groups' development goes on while the leaders continue their own theoretical study of groups at this writing. Groups for pregnant adolescents have ranged from group therapy sessions to structured groups where only didactic material is presented. The literature is somewhat limited in its discussion of types of groups and especially in describing group process. This paper differs from others in that both group structure and process, based on the group objectives, are discussed. Information on approaches beneficial to the adolescent have been included. The goals of the group are to help the teenagers work through the developmental tasks of adolescence and pregnancy and to prepare them for the labor, delivery, and initial parenthood experience. Group structure is based on the intent to engage teenagers in resolution of these tasks in order to be prepared at a variety of levels, i.e. cognitive, emotional, etc., for labor, delivery, and parenthood. Co-leadership of the groups and an unstructured format facilitate the movement of the group toward accomplishment of its objectives. Group content issues were explored and techniques developed to handle these issues were suggested. Included were the following: 1. Commitment to the group by the members is assisted by the structure set for the group and the leaders' active outreach to members. 2. Descriptions of emotions and thoughts are made in concrete rather than abstract terms because of the developmental status of the teenagers. 3. Expression of personal feelings, often difficult for teenagers, is aided by the use of a projective technique. 4. Transition from leader-oriented to group-directed discussion is made possible by the group leaders gradually changing their leadership from one of direct interaction to one of facilitating discussion. 5. Polarization of the group in a negative or positive direction is prevented through the use of a neutral group member or active intervention by the group leaders taking on a neltral role. 6. Control, an issue of pregnancy and adolescence, is dealt with on interactional, educational, and emotional levels. 7. Termination is determined by the stage of the group "work" and is identified and facilitated by the group leaders. Research questions needed to document the effectiveness of the group approach to the pregnant adolescent were addressed.
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Papers by Madeline Schmitt