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Biomedical subjects

Patricia C Dykes

Publications and source records attributed to Patricia C Dykes.

10 recordsLinked to original sources
PubMed2006

Differences in perceptions of empowerment among nationally certified and noncertified nurses.

OBJECTIVE: To examine the difference in perceptions of empowerment between nurses who were nationally certified and those who were not. BACKGROUND: Nurses are encouraged to obtain certification in their specialty. The focus of most nursing research on certification has been on motivation to acquire certification and perceived benefits of certification. Research related to empowerment indicates that access to empowerment structures results in achievement and success. METHODS: This descriptive comparative study used the Conditions of Work Effectiveness II Questionnaire to measure registered nurses' perceptions of empowerment. Certification status was recorded on the demographic section of the questionnaire. RESULTS: Significant differences were noted in empowerment scores for certified and noncertified nurses as measured by the Conditions of Work Effectiveness II Questionnaire. Findings suggest that nurses who are certified have higher perceptions of empowerment. Certification may increase nurses' perceptions of empowerment and therefore improve work effectiveness. CONCLUSION: Certified nurses in this study had increased access to job-related power and opportunity structures. Certification provides recognition of the nurses' knowledge and expertise in the specialty area which in turn is empowering. Organizations that support and recognize this achievement may experience improved turnover and retention rates.

Adult↗
PubMed2006

Exploring the impact of health information technology on communication and collaboration in acute care nursing.

A focus group using nursing informatics experts as informants was conducted to guide development of a survey to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. Through analysis of focus group transcripts, five key themes emerged: information, communication, care coordination, interdisciplinary relationships, workflow, and practice effectiveness and efficiency. This served as the basis for development of a survey that will investigate perceptions of acute care providers across the United States regarding the impact of health information technology on the role of nurses and interdisciplinar communication in acute care settings. The purpose of this paper is to describe the process of survey development including analysis of transcripts, emergence of key themes, and the processes by which the themes will be employed to inform survey development.

Acute Disease↗
PubMed2006

A systematic approach to baseline assessment of nursing documentation and enterprise-wide prioritization for electronic conversion.

An important challenge associated with making the transition from paper to electronic documentation systems is achieving consensus regarding priorities for electronic conversion across diverse groups. In our work we focus on applying a systematic approach to evaluating the baseline state of nursing documentation across a large healthcare system and establishing a unified vision for electronic conversion. A review of the current state of nursing documentation across PHS was conducted using structured tools. Data from this assessment was employed to facilitate an evidence-based approach to decision-making regarding conversion to electronic documentation at local and PHS levels. In this paper we present highlights of the assessment process and the outcomes of this multi-site collaboration.

Delivery of Health Care↗
PubMed2005

Workflow analysis in primary care: implications for EHR adoption.

Within busy practice settings, it is difficult to provide adequate provider training on evolving electronic health record (EHR) functionality. As a result, providers may not reap the full benefits of EHR. This poster presents a systematic workflow study conducted to enhance the adoption of advanced EHR features. This study led us to develop new adoption and training strategies, which resulted in statistically significant (p<0.03) improvement in the adoption of advanced results management features.

Computer User Training↗
PubMed2004

Patient Education and Recovery Learning System (PEARLS) pathway: a tool to drive patient centered evidence-based practice.

Myocardial infarction is a significant problem for Americans and individuals in developed countries. According to the American Heart Association, coronary heart disease is the single largest killer of Americans. Variation in practice is recognized as a key barrier to promoting positive outcomes in patients with cardiac illness. Implementation of clinical practice guidelines has been identified as one way to promote evidence-based practice, reduce practice variation, and ultimately improve the quality of care and outcomes of cardiac patients. Improving patient knowledge and understanding of guideline recommendations and the ways in which evidence-based recommendations are linked to recovery is recognized as one means of facilitating guideline adherence. Automated patient pathways are proposed as a means to improve patient access to guideline-based information at the point of care. Within this context, the prototype development of a Patient Education And Recovery Learning System, or PEARLS, is discussed along with the potential benefits of the use of automated patient pathways as one means for overcoming challenges associated with acute care patient education and facilitating patient adherence to clinical practice guideline recommendations.

Evidence-Based Medicine↗
PubMedDate not supplied

Adequacy of evolving national standardized terminologies for interdisciplinary coded concepts in an automated clinical pathway.

PURPOSE: The purpose of this analysis was to determine the adequacy of evolving national standardized terminologies with regard to coded data elements (concepts) in an automated clinical pathway designed to drive adherence with the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for Evaluation and Management of Chronic Heart Failure. METHOD: Concepts were identified in a previously developed automated clinical pathway and associated tools. Once identified, concepts were categorized according to the conceptual domains identified by Campbell et al. (1997). A review of evolving national standardized terminologies and coding systems was initiated to determine if the identified concepts had corresponding representation in one of these coding systems. Available codes were then evaluated for adequacy with respect to national guideline adherence measures put forth by the Centers for Medicare/Medicaid Services (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO). RESULTS: The concept domain model put forth by Campbell et al. (1997) worked well for organizing concepts and for providing a useful framework for data analysis. Using our method, 260 unique pathway concepts were identified, of which, 91.9% (239) are represented by one or more of the standardized coding systems. Logical Observation Identifiers Names and Codes (LOINC) and SNOMED CT alone represented 86.2% of the concepts. Seventy percent (70%) of the clinical pathway concepts are represented using the Health Insurance Portability and Accountability Act (HIPAA) mandated national terminologies alone. Less than 50% of CMS and JCAHO guideline adherence concepts were found to have representation in the HIPAA mandated terminologies. The addition of Logical Observation Identifier Names and Codes (LOINC) and SNOMED CT improved representation up to 86.4%, but did not include representation of all concepts necessary for complete electronic monitoring of guideline adherence. CONCLUSIONS: Evolving national standardized terminologies provided matching terms for the majority of the data elements in the automated clinical pathway. Standard clinical terminologies with granular terms such as LOINC and SNOMED CT are required to represent the depth and detail of certain procedures and guideline-based care. Gaps exist in Health Insurance Portability and Accountability Act (HIPAA) mandated terminologies for representing interdisciplinary concepts in national adherence measures.

Computational Biology↗
PubMedDate not supplied

Practice guidelines and measurement: state-of-the-science.

BACKGROUND: Restructuring of the health care system has exposed widespread evidence of practice variability and has highlighted the benefits associated with nurses embracing interdisciplinary, best practice solutions to health care delivery. Clinical practice guidelines have emerged as a valuable interdisciplinary evidenced-based tool. PURPOSE: This article explores the state of the science of guideline measurement and evaluates the strengths and weaknesses of measurement approaches. METHOD: A computerized search of Cumulative Index of Nursing and Allied Health Literature, Health and Psychosocial Instruments, Medline, and PubMed for the search term "practice guidelines" was combined with the following key words: attitudes, adherence, effect, impact, instrument, and measurement. DISCUSSION: Measurement issues identified in this analysis are related to the manner in which guidelines are written and the lack of a standard methodology for measurement. CONCLUSIONS: The challenge remains to establish sound measures of adherence and impact while controlling for confounding variables. Questions remain as to the format of practice guidelines to best grant autonomy while offering recommendations that are clear and measurable.

Guideline Adherence↗
PubMedDate not supplied

Clinical practice guideline adherence before and after implementation of the HEARTFELT (HEART Failure Effectiveness & Leadership Team) intervention.

HEART Failure Effectiveness & Leadership Team (HEARTFELT) is a multifaceted intervention designed to improve adherence with the American College of Cardiology/American Heart Association practice guidelines for heart failure (HF). The purpose of this study was to assess differences in clinician adherence with clinical practice guidelines before and after implementation of HEARTFELT. A quasi-experimental, untreated control group design with separate pretest/posttest samples was employed at a community hospital in Connecticut. The untreated historical control group included patients aged 65 years or older with HF and a nonequivalent comparison group of patients with stroke. The posttest samples included patients with the diagnosis of HF and stroke admitted after implementation of the HEARTFELT intervention. The HEARTFELT intervention included automated pathway in electronic medical record (order sets, interdisciplinary plan of care, self-management plan), access to evidence for clinicians and patients, HF self-management education tools, and ongoing discipline-specific feedback regarding adherence. Data were analyzed using parametric and nonparametric methods. The HEARTFELT intervention significantly improved clinician adherence with addressing all self-management categories in the electronic medical record (P = .000) and adherence with self-management education given to the patient in writing at discharge (P = .000). There were no significant differences in adherence with medical interventions (P = .39). While guideline adherence is associated with less practice variation and improved processes, methods of integration into practice in community hospital settings have been largely unexplored. The multifaceted HEARTFELT intervention is promising for its potential to integrate evidence at the point of care, to reduce unwarranted variation in practice, and ultimately to improve the outcomes of individuals with HF.

Aged↗