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Kathryn H Bowles

Publications and source records attributed to Kathryn H Bowles.

11 recordsLinked to original sources
PubMed2006

Introducing standardized terminologies to nurses: Magic wands and other strategies.

Information technology advances have created a revolution that is transforming health care delivery. Practice, documentation, and communication are becoming data-driven. As a result, vendors are rapidly developing and upgrading their computerized clinical information systems; more health care providers are purchasing and implementing these systems. Many systems include standardized terminologies intended for use by nurses. It is imperative that nurses use these terminologies accurately and consistently in order to generate high-quality clinical data. Leaders and terminology committee members employed at practice, education, and research sites need to develop educational strategies to support nurse users as part of well-organized, systematic introductory programs Program requisites include a long-term vision, teamwork, positive attitudes, and adequate resources. This paper is designed to summarize standardized terminologies, benefits and challenges for nurse users, and educational strategies to introduce the terminologies to nurses successfully. The authors will describe the planning, implementation, and evaluation-maintenance strategies they used to introduce the Omaha System to diverse groups.

Humans↗
PubMed2006

Three decades of Omaha System research: Providing the map to discover new directions.

The Omaha System is a classification system or standardized terminology designed to enhance practice, documentation, and information management. Fifty unique studies were identified that focused on the Omaha System's Problem Classification Scheme, the Intervention Scheme, and the Problem Rating Scale for Outcomes. A computerized search of the research literature used CINAHL, MEDLINE, and Dissertation Abstracts databases for the years 1982 to 2003 on the keyword, Omaha System. Nursing studies predominated and were organized into eight categories. Based on the review, recommendations were made for future Omaha System research.

Biomedical Research↗
PubMed2003

Screening for risk of rehospitalization from home care: use of the outcomes assessment information set and the probability of readmission instrument.

The purpose of this study was to evaluate the Outcomes Assessment Information Set (OASIS) compared with the Probability of Readmission (P(ra)) instrument for use in predicting rehospitalization during home care. Using logistic regression and receiver operating characteristic (ROC) curve analysis, the P(ra) instrument was found to be significantly better at predicting rehospitalization than the OASIS case mix weight, clinical, or service scores. The area under the curve (AUC) for the P(ra) was .686 compared with .549 for the OASIS case mix weight (p =.010). Similar results were found for the OASIS clinical and service scores. The AUC for the function score of >/=2 (.599) provided the closest approximation to the P(ra) (.686), and the difference between the two was not statistically significant (p =.120). The OASIS function score could be used to identify at-risk home care patients without having to also use the P(ra) instrument.

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PubMed2003

Hospital discharge referral decision making: a multidisciplinary perspective.

Patients discharged without home care referral were presented as case studies to nurses, social workers, physicians, and discharge planners experienced in discharge planning. Observations and tape-recorded interviews were used to identify patterns clinicians used when gathering information, determine information essential to discharge referral decisions, and explore why patients in need may not be referred for service. Clinicians collected information randomly, and content analysis of their interviews identified mental and functional status, treatment adherence, medical and co-existing conditions, medication management, social support, and prior hospitalization as essential information. Three themes describe why patients may not receive needed referrals: patient characteristics, workload and staffing, and educational issues. Suggestions for improved practice and further research are based on these themes.

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PubMed2002

Patient characteristics at hospital discharge and a comparison of home care referral decisions.

OBJECTIVES: Describe the characteristics of hospitalized older adults who were not referred for home care, compare the referral decisions of hospital clinicians with those of nurses with expertise in discharge planning and transitional care, and compare the characteristics of hospitalized older adults who did not receive a home care referral with patients who did receive a home care referral. DESIGN: Secondary analysis, descriptive, case series. SETTING: Subjects were discharged to home from one of two urban hospitals in Philadelphia, Pennsylvania. PARTICIPANTS: Ninety-nine patients for this study were drawn from the control group (n = 186) of a prior randomized clinical trial of advanced practice nurse hospital discharge planning and home follow-up. These 99 patients, or 56 of the control group, did not receive a home care referral even though they were screened into the original study as meeting at least one of the risk criteria associated with poor postdischarge outcomes. MEASUREMENTS: Case studies were generated from research records of the control group patients who did not receive a home care referral. They included patient sociodemographic and health characteristics. Nurses with expertise in discharge planning and transitional care, blinded to the actual decision, reviewed each case study and made a referral decision. RESULTS: Case studies revealed that control group patients, discharged without home follow-up, had many characteristics associated with the need for a home care referral, with the likelihood of receiving a referral, or with developing poor postdischarge outcomes. Overall, compared with control group patients who did not receive home care, those who did were older, had a longer hospital stay, more often rated their health as fair or poor, and had worse functional status. However, transitional care nurses judged that 96 of 99 of the control group patients discharged without home care had unmet discharge needs that may have benefited from a postdischarge referral. In addition, the transitional care nurses identified 49 of these 99 patients as having a high-priority need for home care. These patients had at least three of the characteristics associated with the need for a home care referral, the likelihood of receiving a referral, or of developing poor postdischarge outcomes. High-priority patients were significantly different in many sociodemographic and health characteristics and were rehospitalized significantly more often than other control group patients who were discharged without home care (P = .032). CONCLUSION: Study findings have demonstrated that the majority of older adults in this sample were discharged without postdischarge referrals despite the presence of several characteristics associated with the need for home care and risk of poor discharge outcomes. Findings suggest the need for improved methods to identify and synthesize patient characteristics associated with the need for postdischarge referral and to support clinical decision-making. Insurance or homebound status should also be explored as barriers to patients receiving the postdischarge care that they need.

Aftercare↗
PubMed2002

Teaching self-management of diabetes via telehomecare.

This study demonstrates that telehomecare is an effective way to improve patient education and self-management outcomes. The cost effectiveness of this technology makes it an attractive medium for reaching patients who require close monitoring, reinforced teaching, and reassurance. telehomecare can also support caregivers and connect socially isolated individuals to their care providers. The possibilities for using telehomecare are just beginning to be realized. With the advent of PPS, telehomecare may be an effective substitute for visits that focus on teaching and monitoring. It is a new tool in the arsenal for the home care nurse to use for monitoring patients and promoting knowledge and behavior change. The video visits are short, focused opportunities for increased patient teaching; the one-on-one focus, audio-visual aids, and opportunities for patients to use the machines to self-monitor are all positive aspects.

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PubMed2002

Lessons learned from a telehomecare project.

This article provides an update on the results of the Telehomecare Project, a demonstration funded by the US Department of Commerce through its Technology Opportunity Program. The goal of the project was to demonstrate and evaluate the use of telephone-based information technology (IT) in the provision of home health services. This effort was described in the August, 1999 (vol. 18, no. 8) issue of CARING.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Applying research evidence to optimize telehomecare.

Telemedicine is the use of technology to provide healthcare over a distance. Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. Most home care agencies are adopting telehomecare to assist with the care of the growing population of chronically ill adults. This article presents a summary and critique of the published empirical evidence about the effects of telehomecare on older adult patients with chronic illness. The knowledge gained will be applied in a discussion regarding telehomecare optimization and areas for future research. The referenced literature in PubMed, MEDLINE, CDSR, ACP Journal Club, DARE, CCTR, and CINAHL databases was searched for the years 1995-2005 using the keywords "telehomecare" and "telemedicine," and limited to primary research and studies in English. Approximately 40 articles were reviewed. Articles were selected if telehealth technology with peripheral medical devices was used to deliver home care for adult patients with chronic illness. Studies where the intervention consisted of only telephone calls or did not involve video or in-person nurse contact in the home were excluded. Nineteen studies described the effects of telehomecare on adult patients, chronic illness outcomes, providers, and costs of care. Patients and providers were accepting of the technology and it appears to have positive effects on chronic illness outcomes such as self-management, rehospitalizations, and length of stay. Overall, due to savings from healthcare utilization and travel, telehomecare appears to reduce healthcare costs. Generally, studies have small sample sizes with diverse types and doses of telehomecare intervention for a select few chronic illnesses; most commonly heart failure. Very few published studies have explored the cost or quality implications since the change in home care reimbursement to prospective payment. Further research is needed to clarify how telehomecare can be used to maximize its benefits among diverse adult chronic illness populations.

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