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Biomedical subjects

K K Hughes

Publications and source records attributed to K K Hughes.

13 recordsLinked to original sources
PubMed1993

Is there a difference? Nursing in proprietary and nonprofit nursing homes.

Nurses working in proprietary and nonprofit nursing homes allocate their time in similar ways across various job responsibilities. Nurses who work in nursing homes obtain health histories and perform physical and psychosocial assessments on very few patients, regardless of home ownership. Compared with nurses who work in nonprofit nursing homes, nurses who work in proprietary homes perform significantly more physical examinations on their patients. Nurses employed by proprietary and nonprofit nursing homes receive similar hourly wages, but those employed in proprietary nursing homes receive fewer fringe benefits.

Aged↗
PubMed1993

Decision making by patients with breast cancer: the role of information in treatment selection.

In recent years, patients have become more involved in the clinical decision-making process, yet the nature of this process, including the role of information, is poorly understood. The purpose of this exploratory study was to examine the relationship between information about breast cancer treatment alternatives and patients' choices of treatments. The target population was all patients with breast cancer in the process of deciding between breast conservation (lumpectomy plus irradiation) and more traditional management (modified radical mastectomy, with or without reconstruction). A convenience sample of 71 female patients with stage I or II breast cancer was drawn from a breast clinic affiliated with a 1,000-bed tertiary medical center. The amount of information provided to each subject and the nature of its presentation were recorded using an observer checklist. Recall of information and final treatment selection were ascertained during telephone interviews conducted six to eight weeks after surgery. The results indicate that subjects' choice of treatment was unrelated to the amount of information they received during the clinic visit. Manner of presentation also did not influence treatment selection. However, treatment selection was related to the amount of information subjects received prior to their clinic visit (p < 0.01). The results also indicate that patients' recall of information about treatments and associated risks is exceedingly poor. Clinical and legal implications are discussed and recommendations for further research are offered in this article.

Adult↗
PubMed1993

Psychosocial and functional status of breast cancer patients. The influence of diagnosis and treatment choice.

This exploratory study examined breast cancer patients' psychosocial and functional status at the time of diagnosis and during the initial phase of treatment. The purpose was to better understand the impact of diagnosis and treatment on patients' physical state and psychosocial well-being. A convenience sample was drawn from a population of newly diagnosed stage 1 and 2 breast cancer patients undergoing either modified radical mastectomy or lumpectomy with radiation. Subjects completed instruments designed to measure uncertainty, quality of life, functional status, and reaction to diagnosis on two separate occasions: at the time of diagnosis, but before treatment selection and then approximately 8 weeks after surgery. Data obtained from 52 subjects indicated that patients' perceptual uncertainty and various aspects of their functional status declined over the initial course of treatment, but that quality of life was unaffected. The results also showed no relationship between type of breast cancer treatment and patients' uncertainty, quality of life, and functional status. Mastectomy and lumpectomy patients also responded in similar ways to the cancer diagnosis. Both groups experienced the same amount of distress and used conformational coping strategies to similar degrees. Clinical implications are discussed and recommendations are made for future research.

Activities of Daily Living↗
PubMed1991

Recruitment, retention, and compensation of agency and hospital nurses.

Despite the increased use and considerable cost of using supplemental nursing services, almost nothing is known about agency nurses or how they might differ from their hospital counterparts. The purpose of this study was to examine recruitment-, retention-, and compensation-related differences between agency and hospital staff nurses. The authors discuss implications for nurse administrators and provide recommendations for maximizing the work force participation of less costly part-time hospital staff nurses.

Career Mobility↗
PubMed1991

Compensation of home health, public health, and hospital nurses. Extrinsic and intrinsic rewards.

Despite the proliferation of home health agencies and increased numbers of nurses working in these settings, little is known about home health nurses or how they might differ from their public health and hospital counterparts. The authors discuss differences in monetary compensation and skill usage, as well as the relationship between compensation and retention, among hospital, home health, and public health staff nurses. The results show that these nurses receive different intrinsic and extrinsic rewards and that their reasons for remaining with their employers are similar, yet unique. Implications for nurse administrators and educators are discussed, along with recommendations for further research.

Attitude of Health Personnel↗
PubMed1990

The relationship between task complexity and decision-making consistency.

The purpose of this study was to examine the relationship between task complexity and decision-making consistency using a normative decision model. The Decision Analytic Questionnaire (DAQ), an instrument designed to measure nurses' decision making under increasingly uncertain and complex conditions, was administered to a stratified random sample of 101 paid volunteer medical-surgical nurses drawn from three public teaching hospitals. Probit analysis was used to construct a profile of the decision maker whose decisions coincided with those of the model. Results indicated that nurses made clinical decisions that coincided with those recommended by a normative decision model but that agreement diminished as task complexity increased (p less than .005). The results also indicated that consistency was task specific, that predictive variables were a function of decision task and that more predictor variables were needed to explain consistency as task complexity increased.

Clinical Competence↗
PubMedDate not supplied

The use of decision analysis to examine ethical decision making by critical care nurses.

OBJECTIVE: To examine the extent to which critical care staff nurses make ethical decisions that coincide with those recommended by a decision analytic model. DESIGN: Nonexperimental, ex post facto. SETTING: Midwestern university-affiliated 500 bed tertiary care medical center. SUBJECTS: One hundred critical care staff nurses randomly selected from seven critical care units. Complete responses were obtained from 82 nurses (for a final response rate of 82%). MEASURES: The dependent variable--consistent decision making--was measured as staff nurses' abilities to make ethical decisions that coincided with those prescribed by the decision model. Subjects completed two instruments, the Ethical Decision Analytic Model, a computer-administered instrument designed to measure staff nurses' abilities to make consistent decisions about a chemically-impaired colleague; and a Background Inventory. RESULTS: The results indicate marked consensus among nurses when informal methods were used. However, there was little consistency between the nurses' informal decisions and those recommended by the decision analytic model. Although 50% (n = 41) of all nurses chose a course of action that coincided with the model's least optimal alternative, few nurses agreed with the model as to the most optimal course of action. The findings also suggest that consistency was unrelated (p > 0.05) to the nurses' educational background or years of clinical experience; that most subjects reported receiving little or no education in decision making during their basic nursing education programs; but that exposure to decision-making strategies was related to years of nursing experience (p < 0.05). CONCLUSIONS: The findings differ from related studies that have found a moderate degree of consistency between nurses and decision analytic models for strictly clinical decision tasks, especially when those tasks were less complex. However, the findings partially coincide with other findings that decision analysis may not be particularly well-suited to the critical care environment. Additional research is needed to determine whether critical care nurses use the same decision-making methods as do other nurses; and to clarify the effects of decision task (clinical versus ethical) on nurses' decision making. It should not be assumed that methods used to study nurses' clinical decision making are applicable for all nurses or all types of decisions, including ethical decisions.

Adult↗
PubMedDate not supplied

Decision making. Stability of clinical decisions.

Clinical decisions of 101 medical-surgical nurses were examined for stability. Results indicate that slightly more than 50% of the subjects made stable clinical decisions or decisions not likely to be reversed with minor changes in the clinical data. The findings also reveal that stability was related to hospital setting and country in which the nurses received their education. The authors provide possible explanations for these observations, and recommendations for nursing education and practice.

Clinical Competence↗
PubMedDate not supplied

N-way sensitivity analysis: a verification and stability-assessment technique for completely subjective decision analysis trees.

The purpose of this paper is to describe the development of N-way sensitivity analysis, a modified version of traditional sensitivity analysis that was created for the purpose of verifying the stability of decisions made by a completely subjective decision-analytic tree. The technique was developed during research that addressed whether nurses make clinical decisions that coincide with those recommended by a decision-analytic model. Since all parameters of the model were derived from subjective assessment, traditional one-way or two-way sensitivity analysis was deemed inappropriate. Consequently, N-way sensitivity analysis was developed and used for the verification of the decision model's results.

Analysis of Variance↗
PubMedDate not supplied

Effects of patient education on decisions about breast cancer treatments: a preliminary report.

The authors examined the effects of materials for educating patients about treatment options for breast cancer on knowledge about the disease, preferences for alternative treatments, and how changes in knowledge and preferences were related. Eighty-two undergraduate students acted as advisors to a hypothetical patient. They completed a knowledge test and rated their preferences for three options--breast-sparing surgery with radiation, mastectomy followed by reconstructive surgery, and mastectomy followed by use of a breast prosthesis--before and after viewing a videotape or a booklet version of the educational materials. Both formats increased knowledge scores. Treatment preferences were not affected by reading the booklet, but viewing the videotape resulted in a preference shift toward breast-sparing surgery. This media difference may be due to features of the video that were not reproduced in the booklet, such as interviews with other patients. Knowledge gains were uncorrelated with preference changes.

Adolescent↗