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Biomedical subjects

D L Wells

Publications and source records attributed to D L Wells.

At least 37 records · Page 2Linked to original sources
PubMed1997

Elderly patients' experiences with nurses guided by Parse's theory of human becoming.

The purpose of this study was to describe the experience of being cared for by nurses who are guided by Parse's theory of human becoming from the perspective of hospitalized elderly patients. Open-ended interviews were used to collect data from a sample of 10 patients. The descriptions obtained from the interviews were analyzed using Colaizzi's phenomenological method. Three common themes constituted an exhaustive description of patients' experiences of relating to their nurses: coming together around instrumental tasks, nurses being there for patients, and nurses' pleasing way. These patterns of relating with nurses signify that patients felt both cared for and looked after. The findings suggest that Parse's theory of human becoming may provide one framework to ensure that caring takes place between nurses and their patients. The study has implications for nursing practice and research.

Aged↗
PubMed1997

Conspiring to succeed: the process of a joint military health care merger.

Congress has mandated that the military services improve their health care systems to improve access, assure high-quality care, provide more choices, and contain costs. In response, the Department of Defense established the TRICARE system, organizing it geographically into 12 health services regions. This paper tracks the efforts of one of those 12--region IV--to plan for this change using strategic planning. Region IV's board of governors represents military facilities in Mississippi, Florida, Alabama, Tennessee, and Louisiana, including one clinic managed by the U.S. Coast Guard, Department of Transportation. Strategic planning usually involves people who know each other and work together. Because of the joint nature of this effort, the members were unfamiliar with one another and with the others' systems. There were also physical distances to overcome. This paper documents that unique experience, likened to a "corporate merger," and the lessons learned from it.

Delivery of Health Care↗
PubMed1996

Genital trauma in young boys.

The issues surrounding genital trauma to young boys has received little attention in recent literature. Five cases of genital trauma are described. The cases demonstrate a number of similar features in their injury pattern. Analysis of the wound pattern will usually assist in defining the injurious force. The circumstances of causation, in particular the non-sexual nature of the genital assault, warrant careful investigation and assessment.

Journal Article↗
PubMed1995

A visuospatial dysfunction following posterior cortex injury is attenuated by postinjury administration of the ACTH4-9 analog ORG 2766.

Rats were trained in a Y-shaped water maze to discriminate a light gray from a medium gray visual stimulus. The latter stimulus card cued the location of a nonvisible escape platform. The animals received either a sham operation or a large ablation in the posterior neocortex, and osmotic minipumps were implanted subcutaneously in the animal's back. The pumps chronically administered either saline or ORG 2766 at a rate of 0, 1, or 10 micrograms per 24 h for 14 days while the animals recovered in individual rat cages. Four weeks after surgery retention of the discrimination was tested and, for those reattaining criterion, transposition of the habit to a pairing of the medium gray card with a black stimulus card was assessed. Animals treated with 10 micrograms ORG 2766 reattained criterion on the original discrimination more rapidly than did animals treated with 0 or 1 microgram. Neither the lesion nor the drug resulted in consistent influences upon transposition. There was no evidence that the drug protected neurons within the dorsal lateral geniculate nuclei. Postinjury treatment with some doses of ORG 2766 can attenuate the severity of some dysfunctions that accompany neurotrauma by influencing the development of behavioral compensation.

Adrenocorticotropic Hormone↗
PubMed1995

Unilateral injury of posterior parietal cortex and spatial learning in hooded rats.

The influences of bilateral or unilateral injuries within the posterior parietal cortex (PPC) upon spatial learning in a water maze were examined in three experiments. Place-learning and response-learning were investigated in a four-alley 'Greek-cross' shaped water maze with extra-maze visual cues available. No differences were detected on any of several measures sensitive to learning between the lesion groups on the place-learning task. Microanalysis of behavior within trials revealed that animals with either bilateral or right unilateral PPC injuries committed significantly more total errors, initial alley entrance ('reference memory') errors, and re-entry ('working memory') errors in the response-learning paradigm than did either the control or left PPC-injured rats. No differences were detected between the latter two groups on these measures. Unilateral lesions resulted in asymmetrical placing responses ipsilateral to the injury 10 days after surgery whereas bilateral injuries resulted in asymmetrical placing with mixed directionality. The acquisition of the response-learning problem in the absence of visual cues was studied on animals prepared with unilateral lesions and housed post-operatively either in isolation or in a 'complex environment.' In the absence of visual cues both right and left PPC-injured rats committed more errors than sham controls, and differential post-surgical housing did not attenuate these impairments. These same animals were trained on the landmark navigation task. Although no differences appeared between the lesion groups, a generalized but transient facilitation of learning was observed in animals housed in the 'complex' environment. Unilateral injuries placed in sham controls failed to disturb retention of the landmark navigation strategy. Because none of the PPC-injured animals were deficient in the landmark task, a result which is contrary to observations in other laboratories, the influence of post-surgical recovery interval upon acquisition of the landmark navigation strategy was explored. Animals were prepared with right PPC injuries and trained following either a 5 or 35 day recovery interval. Only those animals limited to the short recovery interval proved to have a spatial deficit in the landmark task. It is concluded that injuries in the PPC of either hemisphere disturb egocentric spatial functions. However, animals with left PPC injuries are able to compensate by using allocentric visual cues if they are available. It is due to the special role played by the right PPC in complex visuospatial functions that animals with this injury are unable to compensate.

Animals↗
PubMed1995

The importance of critical theory to nursing: a description using research concerning discharge decision-making.

Critical theory has emerged as an important research orientation for nursing. It provides for new and broader research questions and offers the potential to extend the knowledge base of nursing. In this paper I describe some applications of Jurgen Habermas's critical theory (1984, 1987) to nursing, using the example of my recently completed doctoral research (Wells, 1994). The theory was employed as a broad perspective for the study in which I investigated the process of decision-making concerning the discharge of elderly patients from the hospital. When data from 31 patient cases were analyzed, the process was found to be determined largely by systemic forces. Habermas's theory was key in understanding the structure of the process as a means-ends, or instrumental one, and in generating ideas for change in the conceptualization of the process of discharge decision making. Critical theory can advance nursing's understanding of the social organization of everyday practice situations and whether and how they might be reorganized.

Decision Making↗
PubMed1993

Lichen sclerosus, genital trauma and child sexual abuse.

OBJECTIVE: To describe the clinical features of lichen sclerosus affecting the genitalia of three unrelated prepubertal girls in whom concerns of sexual abuse had been raised. CLINICAL FEATURES: three girls ranging from 4 to 9 years of age presented with similar genital and anal findings. Their labial skin was atrophic with pale opalescent patches and a variable amount of labial bruising, haemorrhagic blistering and bleeding. In two, the perianal skin was involved in a similar fashion. In each case the hymen was normal with no sign of acute or chronic trauma. CONCLUSIONS: Lichen sclerosus affecting the genitalia of prepubertal females is an uncommon condition that may be mistaken for trauma associated with sexual abuse. An awareness of its clinical features is essential not only for those doctors who examine children for physical signs of sexual abuse but also for primary care doctors who may be confronted with an apparently abused child. Early recognition of this disease should, in the absence of other concerns, prevent unnecessary intervention by police and child protection workers.

Anus Diseases↗
PubMed1992

A content methodology for advancing gerontological nursing practice.

The content methodology process is a method of observation, research, and application that refines the caregiving practice. An application of the content methodology process with cognitively-impaired individuals with dementia is explored, and correlations drawn to language abilities of older patients.

Aged↗
PubMed1991

Getting together: administrative and clinical teamwork creates a geriatric care program for the hospital.

Sunnybrook Medical Centre, Toronto, has designed a written, multidisciplinary program of care for elderly patients in acute care. The program includes specific community outreach activities that support the in-hospital program and addresses the challenges presented by an increasingly aged population. Some of its objectives are to develop a measurement for length of stay patterns, a reduction in the number of patients waiting for relocation to a long-term care institution (commonly and derogatorily referred to as "placement problems") and an increase in patient, family and staff satisfaction. A method for program evaluation is being designed. The program takes a three-level approach to care: (1) the non-problematic elderly patient, (2) the more complex elderly patient and (3) the care of patients who have finished treatment for their acute illness but who require long-term care institutionalization.

Aged↗
PubMed1987

Formulating a restraint use policy.

When the federal government notified Canadian hospital administrators that several deaths had resulted from improper application of physical restraints, we decided to examine our nursing practice in relation to restraint use. The government communiqué indicated that at any one time, up to 10% of a hospital's patient population may be using some form of restraint. A hospital-wide survey indicated that 13.2% of our patients were managed with physical restraints and that insufficient documentation occurred. This was interpreted as a significant clinical-administrative problem and we recognized the need for a formal policy. Other adult care facilities can benefit from our experience in solving this dilemma.

Documentation↗