A message for the teacher.
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Education, Nursing↗
Biomedical subjects
M Johnson
Publications and source records attributed to M Johnson.
Coming down to earth. Interview by Laurence Dopson.
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Crisis Intervention↗
Glomerulonephritis associated with polymyositis.
Five patients with primary idiopathic polymyositis developed proteinuria associated with urine sediment abnormalities. Renal biopsies disclosed a focal mesangial proliferative glomerulonephritis with deposits of immunoglobulin and complement. After treatment of the polymyositis with corticosteroids, proteinuria and urine sediment changes disappeared within 4 to 8 wk along with an improvement in the muscle disease. Although the pathogenesis remains to be determined, immune complexes may be implicated in the etiology of this renal lesion.
Adrenal Cortex Hormones↗
Disciplining learners--what's the point?
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Education, Nursing↗
Flucytosine dosing in an obese patient with extrameningeal cryptococcal infection.
A 31-year-old, obese woman with extrameningeal cryptococcal disease was admitted to the Medical College of Virginia for antifungal therapy. Various physiologic variables influence flucytosine pharmacokinetics, and there are no guidelines for dosing the agent in obese patients. This patient received a dosage based on her ideal body weight, and serum drug concentrations were monitored. She recovered without sequelae.
Adult↗
Prognostic significance of sustained ventricular tachyarrhythmia occurring during dobutamine infusion.
The prognostic significance of a de novo sustained ventricular tachyarrhythmia occurring during a dobutamine infusion is unknown. This study was performed to determine (1) the risk of recurrent ventricular arrhythmia, (2) the safety of future dobutamine infusions, and (3) the role of electrophysiologic testing. The study population consisted of 15 patients, six with coronary artery disease, and nine with idiopathic dilated cardiomyopathy. Mean ejection fraction was 17% +/- 4.1%. The arrhythmia during the infusion was ventricular tachycardia in 13 patients and ventricular fibrillation in two patients and was not associated with preceding hemodynamic instability, electrolyte abnormality, digoxin toxicity, or antiarrhythmic drug therapy. During electrophysiologic testing, 7 of 15 patients had inducible ventricular tachycardia. All patients with inducible ventricular tachycardia were treated with either antiarrhythmic drugs, defibrillators, or ablation. Over a 12.3 +/- 5.2 month follow-up period, all 15 patients received further dobutamine treatment. Seven of 15 (47%) had a recurrent sustained ventricular tachyarrhythmia. Although three of seven recurrences occurred during a dobutamine infusion, all three of these patients had hemodynamically unstable conditions and were receiving high-dose (> 10 micrograms/kg/min) therapy at the time of recurrence. The other four recurrent arrhythmias were not associated with clear precipitating factors. Ejection fraction, origin of left ventricular dysfunction, and inducibility at baseline electrophysiologic testing did not predict arrhythmia recurrence. The de novo occurrence of a sustained ventricular tachyarrhythmia during dobutamine infusion is associated with a significant risk of arrhythmia recurrence (47%), which can occur in the presence or absence of dobutamine therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Nursing management innovations: a need for systematic evaluation.
While emphasis in nursing is placed on research on clinical interventions, there has been little attention to the equally important management interventions. The concept of a management intervention or innovation is introduced here and five types of management innovations in nursing are identified. An overview of the research base for four of the innovations demonstrates the need for systematic evaluation.
Diffusion of Innovation↗
HLA-DR incompatibility predicts heart transplant rejection independent of immunosuppressive prophylaxis.
To determine whether immunosuppressive prophylaxis reduces the effect of HLA-DR incompatibility on rejection, we compared clinical and immunologic variables of patients given horse antithymocyte globulin, OKT3, or no immunosuppressive prophylaxis. Median follow-up was 27 months. Groups were similar in race; preoperative HLA reactivity; ABO matching; number of HLA-A, -B, -C, and -DR mismatches; and rejection severity. Patients given immunosuppressive prophylaxis were younger (p = 0.04), had a greater frequency of preoperative ischemic disease (p = 0.03), and had a higher 6-month rejection rate (p = 0.02). A highly significant association was found between the number of mismatches at the HLA-DR locus and rejection severity (p = 0.005). Within the OKT3-based immunosuppressive prophylaxis group and the no immunosuppressive prophylaxis group a significant association was found between the number of HLA-DR mismatches and rejection severity (p = 0.01 and p = 0.009, respectively). A similar trend was identified in the group given horse antithymocyte globulin-based immunosuppressive prophylaxis. Logistic regression, used to identify independent predictors of rejection, showed that the number of HLA-DR mismatches and not the use or type of immunosuppressive prophylaxis is significantly associated with rejection (p = 0.0009). One-year patient survival was 83% in the group with two HLA-DR mismatches and 85% in the group with one or no HLA-DR mismatch. Thus the lower rejection rates in patients with one or no HLA-DR mismatch were not associated with a 1-year survival, which was better than that of patients with two HLA-DR mismatches. The potential benefit of HLA-DR matching on rejection and patient survival must be confirmed by larger prospective studies.
Adolescent↗
Cigarette smoking behavior and beliefs of Hispanics in California.
We examined the association between ethnicity and cigarette smoking beliefs and behavior in a 1990 random-digit dialing telephone survey of 3,164 Hispanic and 17,975 non-Hispanic white adults in California. Ethnic self-identification and native language were associated with the prevalence of current smoking in women but not in men. However, both male and female Hispanics smoked fewer cigarettes per day than their non-Hispanic counterparts. Hispanics who reported smoking in the past 12 months were more likely than non-Hispanics to have reached the action stage of cessation and to report an attempt to quit smoking. Spanish-speaking Hispanics were most likely to believe in the harmful effects of smoking, but also most likely to believe that smoking was not addictive, that they were not addicted to cigarettes, and that smoking is something everyone should try once. Cessation and prevention programs that target Hispanic populations must be especially sensitive to values and gender-specific acculturation processes that create a discrepancy between the desire to adopt the lifestyles of the dominant society and the recognition of the concomitant health-related risks.
California↗
Collaborative critical care education: the educator link.
This article describes the Houston Area Collaborative Critical Care Program that has had 10,406 attendees in 5 years. Eleven collaborating institutions participate in the modular program. Strategies are identified for development, implementation, and evaluation of the program. The educators' dedication to collaboration is essential to the success of this program.
Critical Care↗
Infection control. An overhaul of home loans.
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Communicable Disease Control↗
Student nurses: novices or practitioners of brilliant care?
Student nurses are assumed to be novices in terms of traditional models of knowledge and skills development. The research described in this paper explored how relatively inexperienced students provide sophisticated care. The idea of 'brilliant care' is used to describe strategies used to improve the care of patients who are deemed difficult to care for. These strategies can contradict norms in the clinical area. The students therefore also had to learn to reconcile these conflicts. The findings of the research are used to challenge the accepted view of expertise in nursing practice. Students learn complex interpersonal skills quickly. The received view of expertise may therefore be excessively professionalised and technological. This paper is an adapted version of a paper presented at the RCN Research Advisory Group Conference in April 1995.
Humans↗
Nursing outcomes classification. An essential element in data sets for nursing and health care effectiveness.
The Nursing Outcomes Classification (NOC) is a comprehensive classification of patient outcomes responsive to nursing interventions. The NOC is complementary to taxonomies of the North American Nursing Diagnosis Association and the Nursing Interventions Classification. The NOC provides the language for the evaluation step of the nursing process and the content for the outcomes element in the Nursing Minimum Data Set (NMDS). The patient information system Patient Care Data Set (PCDS) is a new, computerized health care information system introduced by the Blue Chip Company and the faculty at Wright State University Miami Valley College of Nursing and Health. An important innovation for evaluation of health care delivery and effectiveness, the PCDS is a record of the patient's health/medical history. Documentation and evaluation of health care must include nursing data along with data from all health care disciplines in minimum data sets. Standardized nursing languages are necessary for inclusion of nursing data. The NOC is a comprehensive classification of patient outcomes that are responsive to nursing interventions. It provides a standardized language for the outcomes element of the NMDS, and contains outcomes that can be shared by all health care disciplines. The PCDS is an innovative minimum data set and patient health record system that is consistent with the NMDS. The NOC is a perfect fit for the PCDS.
Data Collection↗
Outcome data accountability.
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Databases, Factual↗
Implementing the Nursing Outcomes Classification in a practice setting.
Outcomes management has received increased attention in the current health care environment, but nursing participation has been limited due to the lack of standardized data about the effects of nursing practice. The Nursing Outcomes Classification (NOC) provides a standardized language that can be used to measure the effects of nursing practice on patient outcomes. An overview of the classification and implementation methods is provided.
Humans↗
Dignified dying as a nursing outcome.
The goal for humanistic end-of-life care is to maintain quality of life and personal dignity. The nursing outcome called "dignified dying" is defined as maintaining personal control and comfort with the approaching end of life and lists indicators for measuring this. These criteria enable nurses to measure the effectiveness of their nursing interventions, monitor patient progress over time, and summarize research data. This article describes the development of this outcome and illustrates its use with a case study.
Adult↗
Practical issues in survey sampling.
This discussion reviews the principles of survey sampling and applies these principles in a study examining nurses' skills (N = 15,540). Three major facets of sampling are outlined-the sample frame, the sample size and the specific design of the selection procedures. The characteristics of a sample frame, precision in sample size estimation, and rules to be used in the selection procedures, are outlined. In addition, the authors recommend how to obtain assistance with these complex procedures and some steps in problem-solving. This paper provides guidance that will enable nurse researchers, using survey methods, to obtain sample estimates that closely resemble the population.
Clinical Nursing Research↗