PURPOSE OF THE STUDY:: To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. PRIMARY PRACTICE SETTING:: Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. METHODOLOGY AND SAMPLE:: Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. RESULTS:: Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:: Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.

BACKGROUND Most people with spinal cord injuries take a long time to recover and return to their previous life activities. Moving forward is connected with the choices people make about what is important, what to do, and how to live life in ways they value. Parse's Theory of Humanbecoming is a human science theory, and its overall aims are to improve the quality of life for clients and their families. METHOD The Parse research method was used to explore the lived experience of moving forward for 15 clients with spinal cord injuries recruited from two Spinal Injury Associations in Taiwan in 2007. Data were collected and analysed through the processes of participant selection, dialogical engagement, extraction-synthesis and heuristic interpretation, as proposed by Parse. FINDINGS The core concepts found were confronting difficulties, going on and finding self-value and confidence, and co-creating successes amid opportunities and restrictions. Thus, the structure of the lived experience of moving forward is confronting difficulties, going on and finding self-value and confidence to affirm one's self while co-creating successes amid opportunities and restrictions. CONCLUSION This study contributes to nursing theory-guided knowledge development from a humanbecoming perspective on the experience of moving forward among clients with spinal cord injury, and informs rehabilitation nurses who use the Humanbecoming theory as a guide to practice to promote moving forward.

This column illuminates nursing practice through two unique theoretical perspectives: Peplau's theory of interpersonal relations and Parse's theory of humanbecoming. Processes of each practice method will be explicated as each is related to a practice scenario. The key differences between Peplau's and Parse's practice methodologies are identified. Nursing is a unique, evolving, everchanging profession for which theory can be used as a guide for practice. This column demonstrates two of these unique theories. Whether through health promotion or quality of life from the person's perspective, theory provides meaning in nursing practice and in everyday life.

A case study of an ethical dilemma concerning twin nine-year-old sisters in a persistent vegetative state is presented. This is illustrated by the use of a systematic ethical framework to examine the case and the resolution, which was ultimately obtained with nurse-parent interrelations, using the human becoming nursing theory.

People recovering from addiction to alcohol or drugs often acknowledge the need for complete change in life pattern orientation in a journey toward healing. Serenity is the hallmark of recovery according to the tenets of 12-step programs, but little is known about the actual experience of serenity in healing from addiction. From a perspective of unitary pattern appreciation and a method of unitary appreciative inquiry, this study explored the experience of serenity among 9 people recovering from alcohol and/or drug addiction. Results are portrayed in both individual and group profiles, depicted in a format that integrates empirical findings as poetry.

In 1999, the Boston-Based Adaptation in Nursing Research Society associates published their analysis of Roy adaptation model-based research. This earlier analysis supported the model's conceptual framework, its adaptive processes, and the influences that effect human responses. The purpose of this article is to describe more recent research within the context of the Roy adaptation model's structural framework, and ongoing developments that include expanded research programs, middle-range theory construction, and research that is related to the philosophic assumptions. An additional aim is to present an expanded worldview or an integrated paradigm that includes both sets of the Roy adaptation model's assumptions (scientific and philosophic), as well as a holistic-adaptation inquiry that could be used to derive Roy adaptation model-based nursing knowledge in future research investigations.

Feeling lonely is a phenomenon experienced by all humans. The purposes of this research study were to discover the structure of the experience of feeling lonely, to contribute to nursing knowledge, and to expand the knowledge of feeling lonely. The Parse research method was used to guide this study and answer the research question: What is the structure of the lived experience of feeling lonely? Participants were 10 children ages 7 to 10 years. The central finding of this study was the following structure: The lived experience of feeling lonely is distressing isolation amid contentedness arising with cherished engagements. New knowledge extended the theory of humanbecoming and enhanced understanding of the experience of feeling lonely.

AIM This paper is a report of the development of a theoretical framework of nursing practice based on the convergence of the concepts art of nursing, presence and caring. BACKGROUND Convergence of similar concepts to form broad yet useful theories is a relatively unexplored area, despite the fact that systematically examining and integrating nursing concepts can help to build theory and leads to enhanced understanding of the discipline. Research results suggest that unarticulated similarities exist among the art of nursing, presence and caring; thus, qualitative convergence of these concepts is justified. DATA SOURCES Findings from qualitative studies of the art of nursing (published between 1993 and the third quarter of 2006) and meta-syntheses of presence and caring (published in 2006 and 2007 respectively) were inductively analysed and integrated. RESULTS A theoretical framework of nursing practice was developed to illustrate the areas of convergence among the concepts art of nursing, presence and caring. Nursing involves an intimate relationship-centred partnership between the nurse and patient. Situation-specific nursing actions result from multiple forms of personal and professional knowledge and are based on a value system of holistic beneficence and patient empowerment. Nursing actions are promoted by a conducive work environment and result in enhanced well-being among patients and nurses. CONCLUSION Results of this concept convergence provide an enhanced understanding of nursing practice and offer insight into areas of nursing practice that are not encompassed within the concepts art of nursing, presence and caring. Further work is recommended to expand the proposed framework, especially in terms of the wide variety of nurse-patient relationships that exist.

The purpose of this study was to answer the research question. What is the structure of the lived experience of contentment? The participants were 10 women volunteers. The Parse research method, a phenomenological-hermeneutic method, was used to uncover the meaning of contentment. The major finding of this study is the structure: Contentment is a satisfying calmness amid the arduous as resolute liberty arises with benevolent engagements. The structure provides knowledge about contentment and its connection to health and quality of life. It is discussed in relation to the principles and concepts of human becoming and in relation to how it can inform future research and practice.

This article reviews the fundamental assumptions of forensic identification ("individualization") science and notes the lack of empirical evidence or theory supporting its typical strong claims. The article then discusses three general research strategies for placing these fields on firmer scientific ground. It concludes by suggesting what forensic identification science experts can do while awaiting that scientific foundation.

The aim of this paper is to examine the role of qualitative research in the development of the Roy adaptation model. An exploration of the findings from qualitative research using Roy's adaptation model from 1995 to 2005 is compared with the findings and recommendations from a previous review over a 25-year period (1970-1995). The usefulness of qualitative methods in furthering nursing theory is highlighted. Findings from both reviews support the assumptions of the model while generating new information and demonstrating the valuable place of qualitative research in promoting nursing science.

Sjöblom et al.(Research Article, 13 October 2006, p. 268) reported many new genes with an apparent significant excess of mutations in breast and colorectal cancer. Reanalysis of their data with more appropriate statistical methods and background mutation rate assumptions reveals that few if any of these genes have significantly elevated mutation rates.

In today's medical marketplace, patients see themselves as consumers of healthcare with certain customer-service expectations. The medical practice that is indifferent or resistant to these changes is at risk. Having a good understanding of patient-friendly changes can help a practice survive in a changing environment. A patient-friendly office will continue to meet the needs of the patient by adopting this new practice style.

This article offers a critique of traditional theories of the Rorschach as a perceptual task, proposes an alternative conception of the task as one of visual representation, and demonstrates the manner in which the latter theory provides a superior explanation of the distinctive quality of the Rorschach stimuli, the ways in which participants and examiners understand the test, the assumptions underlying Rorschach scoring, and the manner in which young children master the test.

This article aims at better grasping the stakes of interdisciplinary work. The interdisciplinary and integrative clinical approach used at the "Consultation interdisciplinaire de médecine et de prévention de la violence")(CIMPV) to address issues of violence is based on the theories of complexity and built upon the confrontation of personal, professional, intra- and inter-institutional logics. It offers a process that is original in terms of assumptions, objectives and practical implications.

Chemical and microbial safety will be one of the major functions of a closed eco-system aboard piloted interplanetary vehicle. Methods for decontamination and preservation of water-containing human wastes (WHW) should be developed on the assumption that WHW are a labile biochemical system biological and chemical processes of which are intricately dependent on preservatives, regenerative water quality, structural material off-gassing, and methods of WHW collection, storage, and management.

To interpret complex and ambiguous input, the human visual system uses prior knowledge or assumptions about the world. We show that the 'light-from-above' prior, used to extract information about shape from shading is modified in response to active experience with the scene. The resultant adaptation is not specific to the learned scene but generalizes to a different task, demonstrating that priors are constantly adapted by interactive experience with the environment.

There is a need to widen the practice of health psychologists to include the theories and methods of community psychology and an awareness of contemporary issues in community health. The aim of such a community health psychology would be both to deepen our understanding of the aetiology of health and illness in society and to develop strategies that will contribute to a reduction in human suffering and an improvement in quality of life. The aim of this article is to review the background and assumptions of community health psychology and to consider some values that would underlie such an approach.

An equation was developed that quantifies the relationship between volatile solids reduction (VSR) calculated by the Van Kleeck and mass-balance equations. Two sets of data were used to illustrate the significance of fixed-solids loss on the agreement between the two methods. The Van Kleeck equation assumes that fixed solids are conserved during the digestion process; however, this assumption is not needed for the mass-balance equation. Therefore, if substantial changes in the fixed-solids concentration occur, the Van Kleeck equation will not be as accurate as the mass-balance equation for computing VSR and will also underestimate VSR.