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Biomedical subjects

M C Corley

Publications and source records attributed to M C Corley.

At least 19 recordsLinked to original sources
PubMed1999

Use of backrest elevation in critical care: a pilot study.

BACKGROUND: Use of lower backrest positions occurs frequently and is a factor in the development of ventilator-associated pneumonia. OBJECTIVES: To determine the usual bed elevation and backrest position in a medical intensive care unit and their relationship to hemodynamic status and enteral feeding. METHODS: Data were collected in a 12-bed medical respiratory intensive care unit for 2 months. A protractor was used to measure the elevation of the head of the bed. Hemodynamic status was defined by systolic, diastolic, and mean arterial blood pressure measurements retrieved from each patient's flow sheet. RESULTS: The sample included 347 measurements of 52 patients. Mean backrest elevation was 22.9 degrees, and 86% of patients were supine. Backrest position differed significantly (P = .005) among nursing shifts (days, evenings, nights) but not for systolic (r = -0.04, P = .49), diastolic (r = 0.01, P = .83), or mean arterial blood pressure (r = -0.01, P = .84). Backrest elevation did not differ significantly between patients who were receiving enteral feedings and patients who were not (P = .23) or between patients receiving intermittent versus continuous nutrition (P = .22). CONCLUSIONS: Use of higher levels of backrest elevation (> or = 30 degrees) is minimal and is not related to use of enteral feeding or to hemodynamic status. The rationale for using lower backrest positions for critically ill patients may be based on convenience, the patient's comfort, or usual patterns in the unit. However, the dangers of supine positioning and its relationship to aspiration and ventilator-associated pneumonia should not be minimized.

Critical Care↗
PubMed1998

Rationing organs using psychosocial and lifestyle criteria.

The role of patient psychosocial and lifestyle characteristics in decisions about the allocation of scarce health care resources has not been examined. In this national survey using the Criteria for Selection of Transplant Recipient (CSTR) Scale, organ transplant coordinators (N = 559) identified the psychosocial and lifestyle criteria they believe should be considered in patient selection/rejection for organ transplant. Using factor analysis to reduce the data, six factors were identified: current lifestyle/psychiatric problems, family/socioeconomic issues, habits, controlled lifestyle/psychiatric issues, cost, and stigmatized conditions. Patients who were in prison for a serious crime, used cocaine, had AIDS, or were HIV positive (criteria making up the Stigma factor), were more likely to be labeled for exclusion from transplant than those with other psychosocial/lifestyle characteristics. When transplant coordinators perceived that patients' psychosocial and lifestyle problems were under control or corrected, they were more likely to consider them for a transplant. For all but the cost factor, criteria were most stringent for heart transplants. Although over 90% of the coordinators assessed patients and participated in patient selection for transplant, master's prepared nurses were more likely than nurses with other educational preparation to be involved in organ recipient selection. These findings can serve as a prototype for how decisions are made for allocating other scarce health care resources.

Adult↗
PubMed1998

Ethical dimensions of nurse-physician relations in critical care.

Recent research findings highlight the importance of nurse-physician collaboration for more positive patient outcomes. Nowhere is this more important than in addressing the ethical aspects of critical care practice. Differences in values, communication, trust, and responsibilities can precipitate conflict between nurses and physicians over ethical components of care. Strategies to address these ethical conflicts and improve nurse-physician collaboration are needed at both the organization and policy level.

Conflict, Psychological↗
PubMed1998

The dark side of nursing: impact of stigmatizing responses on patients.

The current emphasis in nursing is on caring, what it involves and why it is the profession's responsibility. This article focuses on the opposite behaviors--the "dark side of nursing" (Jameton, 1992). By developing a fuller understanding of nurse behaviors labeled the "dark side of nursing," the profession can better comprehend what caring involves and develop innovative ways to reduce dark-side behaviors. Although marginalizing, labeling and stereotyping, and stigmatizing are related, the focus will be on stigmatizing responses to patients. A number of investigators document nurse stereotyping of suicidal patients, persons with AIDS, racial/ethnic groups, and sex offenders and the impact on patients. Social psychological theories on stereotyping and deviant behavior provide some explanation for the nurse's behavior. The organizational perspective, however, has not been employed to enhance our understanding of nor to eliminate this phenomenon. Combining an organizational perspective with the social psychological theory of negative stereotyping (stigmatizing) and philosophical theory involving ethics provides a more comprehensive theory for understanding the "dark side of nursing" and designing interventions to reduce the occurrence of this damaging behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Environmental turbulence: staff nurse perspectives.

The purpose of this qualitative study was to explore staff nurses' perceptions of how turbulence in the internal environment affected their ability to provide patient care. The themes that emerged from the data point toward multiple factors impinging on a staff nurse's ability to provide quality care in today's healthcare environment. The authors discuss these factors, the consequences for staff nurses, patients, and the organization, and the implications for nursing administrators and their colleagues in hospital administration.

Adult↗
PubMed1995

Moral distress of critical care nurses.

BACKGROUND: Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. OBJECTIVE: To present findings on moral distress of critical care nurses, using an investigator-developed instrument. METHODS: An instrument development design using consensus by three expert judges, test-retest reliability, and factor analysis was used. Study participants (N = 111) were members of a chapter of the American Association of Critical-Care Nurses, critical care nurses employed in a large medical center, and critical care nurses from a private hospital. A 32-item instrument included items on prolonging life, performing unnecessary tests and treatments, lying to patients, and incompetent or inadequate treatment by physicians. RESULTS: Three factors were identified using factor analysis after expert consensus on the items: aggressive care, honesty, and action response. Nurses in the private hospital reported significantly greater moral distress on the aggressive care factor than did nurses in the medical center. Nurses not working in intensive care experienced higher levels of moral distress on the aggressive care factor than did nurses working in intensive care. Of the 111 nurses, 12% had left a nursing position primarily because of moral distress. CONCLUSIONS: Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.

Adult↗
PubMed1995

Patient and nurse criteria for heart transplant candidacy.

The criteria nurses and patients believe should be used to allocate hearts for transplantation were explored and compared in a descriptive study. Although the majority of both groups agreed that patients with AIDS or who are HIV positive should not receive a transplant, the two groups agreed very little on the other criteria. This research has implications for clinical care and ethical decision making.

Adult↗
PubMed1994

The clinical ladder. Impact on nurse satisfaction and turnover.

Nurse administrators have advocated clinical ladder programs to address salary compression of experienced nurses. However, few clinical ladder programs have survived the test of time. One possible explanation for the demise of these programs is the failure to assess nurses' satisfaction with clinical ladder programs. Ongoing assessment of these programs may provide a solution to early demise.

Adult↗
PubMed1993

Environments that support ethical nursing practice.

Creating an ethical work environment in a health care organization is both necessary and difficult. In the process of providing care, nurses often make decisions with ethical implications. This decision making is enhanced when the work environment supports an ethical approach. Nursing can implement strategies to support ethical decision making.

Decision Making↗
PubMedDate not supplied

The nurse's multiple commitments.

Nurses have multiple commitments: organizational, work, professional, job, patient, and personnel. Research has focused almost exclusively on organizational commitment and, to a lesser extent, on professional and job commitment. This fragmented approach to the study of the nurse's commitments neglects the nurse's commitment to patients. The concept of commitment needs to be clarified so that knowledge derived from research on commitment enhances our understanding of how nurses manage these multiple commitments.

Clinical Competence↗
PubMedDate not supplied

Prevalence of principled thinking by critical care nurses.

The advanced technology surrounding the nursing care of the acutely ill patient has precipitated many ethical issues. The first step in understanding how nurses respond to these ethical issues is to become familiar with their moral reasoning and use of ethical principles in making decisions. This research report describes the responses of critical care nurses to six vignettes of the Nursing Dilemma Test as a measure of their use of principled thinking to decide on actions in specific ethical situations. Nurses used principled thinking more often to respond to ethical situations than purely practical responses.

Critical Care↗
PubMedDate not supplied

Techniques in evaluating nursing expert systems: A case study.

This study addresses the problems in evaluating nursing diagnostic artificial intelligence (AI) expert systems. Two separate experiments (N = 49) were conducted using a computer expert system. The first experiment, the "white box" experiment (n = 9), compared the diagnostic techniques applied by experience RNs against the programmed techniques used by the expert system. The second experiment, the "black box" experiment (n = 40), compared diagnostic results of beginning nurses against the computer expert systems results. In some cases the computer outperformed the nurses and vice versa. The evaluation techniques, as applied in both experiments, enhance the ability of nurses to evaluate and select AI expert systems to be used in computer-assisted diagnosis of nursing problems.

Clinical Competence↗