Biomedical subjects

S B Henry

Publications and source records attributed to S B Henry.

At least 19 recordsLinked to original sources

PubMed1996

The role of ambulatory care information systems in supporting the provision of holistic care for persons infected with the human immunodeficiency virus.

Given an appropriate conceptual model, such as the Wilson and Cleary model for linking clinical variables with health-related quality of life, ambulatory care information systems have the potential to facilitate holistic care for persons infected with the human immunodeficiency virus. Four examples of the manner in which an ambulatory care system can support the provision of holistic care are the contextualization of care through inclusion of the patient's voice, improved coordination of care and knowledge-harvesting through systems integration, timely application of agency-specific information and domain information and knowledge to an individual patient, and blurring of the boundaries of ambulatory care.

Ambulatory Care Information Systems↗

PubMed1996

Standardized nursing classification systems: necessary, but not sufficient, for representing what nurses do.

The American Nurses Association Steering Committee on Databases to Support Nursing Practice has recognized three standardized nursing intervention classification systems. Because each of these classifications systems focuses on encoding informational abstractions of nursing actions, rather than providing a controlled vocabulary and compositional grammar from which informational concepts and abstractions can be constructed, the systems are necessary, but not sufficient, for representing what nurses do. In particular, computer based patient record systems focused on process understanding and process improvement will require atomic-level representations of nursing actions suitable for transformation into a variety of information abstractions, including, but not limited to, the abstractions contained in the three existing classification systems.

Nursing↗

PubMed1995

Nursing informatics: state of the science.

The phenomena of interest in nursing informatics are nursing data, nursing information and nursing knowledge. The current state of knowledge related to these phenomena suggests four implications for the development of systems to support nursing. First, research has provided evidence that knowledge and experience is related to the quality of nursing assessment, diagnosis or clinical inference, and planning of nursing care, and also that knowledge is task-specific. Information technology can provide access to a variety of information resources, such as knowledge bases and decision support systems, to increase the level of knowledge of the nurse decision-maker. Second, structured patient assessment forms with linkages to knowledge bases of diagnoses have the potential to improve the quality of the patient assessment and the accuracy of the diagnosis or clinical inference. Third, studies on planning care have demonstrated the complexity of the task when a number of options are potentially appropriate. Model-based decision support applications such as decision analysis and multi-attribute utility theory can assist the clinicians and patients to analyse and compare the treatment alternatives in a systematic manner. Fourth, there is modest support for demonstrating the relationship between the process and outcomes of clinical decision making. Large databases built upon nursing data are needed to further examine this relationship.

Expert Systems↗

PubMed1995

Critical care information systems: essential infrastructure for critical care nursing practice.

In the three decades since the installation of the first bedside computer in the "shock ward" at the University of California and Los Angeles County Hospital, both computer technology and critical care practice have evolved rapidly. The premise of this article is that critical care information systems are an essential infrastructure for critical care nursing practice. This premise is described in terms of the critical care environment, clinical decision making in critical care, increasing demands for information about quality and costs, and national initiatives for the sharing of health care information.

Critical Care↗

PubMed1995

A comparison of problem lists generated by physicians, nurses, and patients: implications for CPR systems.

Using a sample of 201 patients hospitalized for Pneumocystis carinii pneumonia, this study describes problem lists generated by physicians and examines the overlap among problem lists generated by physicians, nurses, and patients. The findings indicate that the majority of patients in this sample had at least one problem that occurred in more than one problem list. Problems that most frequently appeared in more than one problem list were those related to the medical diagnosis of Pneumocystis carinii pneumonia and its associated physiological symptoms. Problems which occurred uniquely in the nurse problem list were knowledge deficit and potential for injury. Thirty-four percent of the patients identified at least one psychosocial problem that did not occur in either the physician- or nurse-generated problem lists. The study findings demonstrate that while there is overlap among the problem lists in problems related to the principal medical diagnoses, the nurse- and patient-generated problem lists include unique problems which provide additional significant information related to patient status that has the potential to impact patient outcomes. These findings suggest that a unified, nonredundant, multidisciplinary problem list is warranted in order to provide a comprehensive view of the patient for computer-based patient record (CPR) systems. Appropriate data models and comprehensive controlled vocabularies are needed to support the multiple uses of the problem list for CPR systems.

Humans↗

PubMed1995

A comparison of nursing intervention classification and current procedural terminology codes for representing nursing interventions in HIV disease.

The purpose of this study was twofold: 1) to compare the ability of terms from the nursing intervention classification and from the current procedural terminology to represent the clinical terms used by nurses and patients to describe nursing interventions during hospitalization; and 2) to identify the strengths and weaknesses of the two classification systems for representing nursing systems. More NIC than CPT codes matched the concepts in the clinical terms used by nurses and patients to describe nursing interventions demonstrating, not unexpectedly, that NIC represents a broader scope of nursing practice. The major difficulty encountered using NIC was the lack of mutual exclusiveness of the nursing activities within the interventions. CPT codes were easy to apply to the clinical terms, but were limited in scope for nursing practice. The findings of this study demonstrate the necessity of using a nursing-specific classification system for the representation of nursing interventions. This is of particular importance for databases that will be used to examine the effectiveness of healthcare interventions and for databases related to reimbursement for healthcare interventions.

Databases, Factual↗

PubMed1995

Representing HIV clinical terminology with SNOMED.

1. RESEARCH OBJECTIVES AND METHODS. Because of a need for a standard classification and coding system to encode data for HIV infected patients in the AIDS Program clinic at San Francisco General Hospital, we have begun a subset of clinical terms commonly used in the care of patients with HIV disease, and we have sought to represent these terms using terminology from the SNOMED International classification system. We selected a sample of key findings for AIDS primary care for the AIDS Registry database. The areas of chest x-ray findings, psychological problems, and patient symptoms were chosen because they were representative of a number of SNOMED International axes, including diagnoses, morphology, topography, and function. They also included modifiers representing the concepts of laterality, time, severity, and certainty. 2. RESULTS. As shown by the sample terms in the table below, the findings suggest that SNOMED is a good starting point for a standard classification and coding system to support the clinical care of patients with HIV disease. The next phase of the research will focus on the evaluation of the adequacy and acceptability of the SNOMED representation to clinicians in the AIDS clinic.

HIV Infections↗

PubMed1995

Capturing patients' perceptions in the computer-based patient record: essential prerequisites to the measurement of health-related outcomes.

The cost, quality, and outcomes of healthcare services have become the focus of national attention as providers, consumers, and payers of healthcare services grapple with healthcare reform in the United States. Given the importance of patient care data to the activities of all segments of the healthcare spectrum, the development and implementation of computer-based patient records (CPRs) has been recommended as CPRs have the potential to improve healthcare delivery, enhance outcomes research programs, and increase hospital efficiency [12]. The current paradigm shift in healthcare requires the active involvement of the patient in the delivery and evaluation of care. The patient must be considered as an essential user of CPRs in order to exploit the benefits of information technology for the purposes of outcome assessment. Research and development of the future CPRs must incorporate the needs of the patient. Systems should be designed to meet these needs in order to capture the patient's perceptions in CPRs.

Medical Records Systems, Computerized↗

PubMed1994

The relationship between type of care planning system and patient outcomes in hospitalized AIDS patients.

The purpose of this study was to describe the problems of HIV-infected patients, hospitalized for Pneumocystis carinii pneumonia (PCP), as documented in the nursing care plan and to examine differences in the number and type of activated patient problems and patient outcomes between manually generated, computer-supported, and standardized care planning systems. Of the sample, 22% had no care plan. In the computer-supported care planning system the fewest number of care plans were completed. The total number of problems generated for the 89 patients having care plans was 199. The problems were categorized as PCP-related (37%), AIDS-related (16%), psychosocial (23%), knowledge deficit (14%), and other (10%). There were significant differences among the three groups in the total number of problems, PCP-related problems, and knowledge deficit problems. There were no statistically significant differences in patient outcomes, as measured by HIV-QAM scale scores and patient self-rating of physical condition approximately 1 week after admission, and length of stay among the three care planning systems. Future research is needed to examine the effect of type of care planning system on the quality of patient care.

AIDS-Related Opportunistic Infections↗

PubMed1994

Can SNOMED International represent patients' perceptions of health-related problems for the computer-based patient record?

As the United States moves towards a computer-based patient record, there is much discussion related to the contents of such a record and the manner in which the data elements will be represented. Recent health care reform has emphasized the need for increased patient involvement in health care decision making, however, there has been little discussion about including the patient perspective in the computer-based patient record. Using an existing data set of 201 patients who were hospitalized for Pneumocystis carinii pneumonia, this study examined the ability of SNOMED International to represent patients' perceptions of health-related problems. The majority of concepts used by patients to describe health-related problems could be matched with existing SNOMED terms. The addition of the social context module as an adjunct to existing terminologies of medical diagnoses, NANDA diagnoses, and signs/symptoms provided additional matching terms. Patient goals did not match existing SNOMED terms. The findings of this study suggest that SNOMED International has the potential to adequately represent patients' perceptions of health-related problems for the computer-based patient record. Additional studies are needed that will examine the extent to which patients' perceptions of health-related problems are already documented in the patient record by healthcare providers. The utility of patients' perceptions of health-related problems in the prediction of patient outcomes must also be analyzed.

Attitude to Health↗

PubMed1994

A computer-based approach to quality improvement for telephone triage in a community AIDS clinic.

Observation of the current procedure for telephone triage in a community-based acquired immunodeficiency syndrome (AIDS) clinic and a retrospective chart audit identified opportunities for improvement in the process for the management of telephone triage encounters. Specifically, it pointed out that the nurses faced difficulties in accessing relevant clinical data, and that a large number of data were missing in the documentation for the encounter. Five design goals for a computer-based system to improve the management of the telephone triage encounter were generated by an interdisciplinary project team. A computer-based approach to management of the telephone triage encounter complemented by the development of performance standards and guidelines has the potential to improve both the process of telephone triage and the documentation of the triage encounter.

Acquired Immunodeficiency Syndrome↗

PubMed1993

The HIV quality audit marker (HIV-QAM): an outcome measure for hospitalized AIDS patients.

The development and validation of the HIV-Quality Audit Marker (HIV-QAM), an instrument designed to measure changes in the status of hospitalized AIDS patients due to nursing care, is reported. The HIV-QAM is designed to capture the nurse data-collector's judgment of the status of the patient based upon observations, interviews, record reviews, and listening to inter-shift report. The final version of the 10 item HIV-QAM includes three scales, Self-care (six items; Cronbach's alpha = 0.89), Ambulation (two items, alpha = 0.88), and Psychological Distress (two items, alpha = 0.84). Content validity was supported by selection of items from pre-existing scales, generation of items based on care plans for HIV/AIDS patients, and review and critique of items by a panel of nurse experts. Construct validity was supported by principal components factor analysis and multi-trait scaling analysis. Convergent and divergent concurrent validity with patient symptoms and intensity of nursing care required was demonstrated. The predictive validity of the HIV-QAM for mortality at 3 and 6 months after hospital treatment for Pneumocystis carinii pneumonia was also shown.

Activities of Daily Living↗

PubMed1993

AIDS2: a decision-support tool for decreasing physicians' uncertainty regarding patient eligibility for HIV treatment protocols.

We have developed a decision-support tool, the AIDS Intervention Decision-Support System (AIDS2), to assist in the task of matching patients to therapy-related research protocols. The purposes of AIDS2 are to determine the initial eligibility status of HIV-infected patients for therapy-related research protocols, and to suggest additional data-gathering activities that will decrease uncertainty related to the eligibility status. AIDS2 operates in either a patient-driven or protocol-driven mode. We represent the system knowledge in three combined levels: a classification level, where deterministic knowledge is represented; a belief-network level, where probabilistic knowledge is represented; and a control level, where knowledge about the system's operation is stored. To determine whether the design specifications were met, we presented a series of 10 clinical cases based on actual patients to the system. AIDS2 provided meaningful advice in all cases.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Representation of nursing terms for the description of patient problems using SNOMED III.

We conducted an experiment to determine if the terms recorded by nurses in the patient chart to describe patient problems could be represented using SNOMED III terms. The data sources for the patient problems were the nurses' progress notes and nursing care plans from 485 patient encounters in three diverse settings (NR02215). We entered the nursing terms into a relational database. We loaded the SNOMED III terms into a relational database and created a word index. We determined matches by identifying the English description of the SNOMED III term that best matched the term charted by the nurses. Sixty-nine percent of the nursing terms in the test subset were matched using one or more SNOMED III terms. We identified redundant SNOMED III terms for several nursing terms including fear and diarrhea. Our results suggest that terms recorded by nurses in the patient chart can be represented using SNOMED III terms. Further enhancement and refinement will improve the domain completeness of SNOMED III as a controlled healthcare vocabulary and decrease redundancies.

Humans↗

PubMed1992

Patients' perceptions of pulmonary problems and nursing interventions during hospitalization for Pneumocystis carinii pneumonia.

BACKGROUND AND METHODS: The descriptive, correlational study examined patients' perceptions of pulmonary problems and nursing interventions in a sample (n = 201) of persons living with AIDS hospitalized for Pneumocystis carinii. Additionally, the study assessed differences in physiological variables, patient symptoms, and functional status based on the type of problems identified: dyspnea, pulmonary problems without dyspnea, and nonpulmonary problems. RESULTS: A total of 601 problems was identified including 61 instances of dyspnea and 83 reports of other pulmonary problems. The remainder of the problems was nonpulmonary. Nursing interventions associated with dyspnea and pulmonary problems other than dyspnea were mainly broadly defined interventions such as oxygen and medication administration. When patients were placed into three groups based on identification of dyspnea, pulmonary problems without dyspnea, or only nonpulmonary problems, there were no differences between groups in functional status or patient symptoms of pain, nausea, or fatigue as measured by the Quality Audit Marker. CONCLUSIONS: This study demonstrated that hospitalized patients with Pneumocystis carinii present with a broad array of problems. Contrary to expectations, dyspnea was not ubiquitous but was reported by less than one-third of this sample. When dyspnea was present there were few independent nursing interventions that patients identified. Studies are needed to test effective strategies for the nursing management of dyspnea and a large variety of other patient problems associated with HIV infection.

AIDS-Related Opportunistic Infections↗

PubMed1992

Computerized clinical simulations: a strategy for staff development in critical care.

BACKGROUND: Identifying the learning needs of employees and evaluating the results of staff development offerings are essential elements of the responsibilities of the staff development educator. High patient acuity, the shortage of critical care nurses, and rapidly changing technology within the critical care environment demand the provision of staff development offerings that are appropriate for the learning needs of critical care nurses and the evaluation of the effect of programs on critical care nursing practice. OBJECTIVE: The purposes of this descriptive, correlational study were to compare the ability of a knowledge test, a self-evaluation tool, and computerized clinical simulations to discriminate between nurses with varied levels of knowledge and experience, and to compare the learning needs identified from the three types of evaluative instruments. METHODS: Each subject (n = 142) completed the Basic Knowledge Assessment Tool for Critical Care, Cardiovascular Self-Evaluation Tool, and four computerized clinical simulations. RESULTS: Both the Basic Knowledge Assessment Tool and the Cardiovascular Self-Evaluation Tool discriminated between experienced/inexperienced and Advanced Cardiac Life Support-certified/noncertified critical care nurses. The computerized clinical simulations discriminated according to Advanced Cardiac Life Support certification, but not between experienced and inexperienced critical care nurses. The computerized clinical simulations identified more specific learning needs than did the Basic Knowledge Assessment Tool or Cardiovascular Self-Evaluation Tool. CONCLUSIONS: The evidence for discriminant validity, adequate internal consistency reliability, and ease of administration supports the continued use of these two tools as methods for critical care staff development needs assessment and evaluation. In addition, the study findings support the use of computerized clinical simulations as an adjunct to other needs assessment and evaluation methods in nursing staff development.

Adult↗

PubMed1992

A needs analysis for computer-based telephone triage in a community AIDS clinic.

This study describes the complexity of the telephone-triage task in a community-based AIDS clinic. We identify deficiencies related to the data management for and documentation of the telephone-triage encounter, including inaccessibility of the medical record and failure to document required data elements. Our needs analysis suggests five design criteria for a computer-based system that assists nurses with the telephone-triage task: (1) online accessibility of the medical record, (2) ability to move among modules of the medical record and the triage-encounter module, (3) ease of data entry, (4) compliance with standards for documentation, and (5) notification of the primary-care physician in an appropriate and timely manner.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Critical care management of the patient with HIV infection who has Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) is the most frequently occurring opportunistic infection in individuals infected with the human immunodeficiency virus. Improved methods of diagnosing and treating PCP have resulted in increased survival rates. Nurses are more frequently faced with treatment of the critical care patient with PCP. Knowledge about the mechanisms and manifestations of PCP as well as its diagnosis and treatment provides a baseline for the nursing management of PCP. Nursing care for the critically ill adult patient with PCP focuses on the management of the human responses to PCP including hyperthermia, impaired gas exchange, altered respiratory function, fatigue, and altered nutrition, and on the management of the side effects of treatment including nausea, vomiting, and hypoglycemia. Effective interventions related to these patient problems can improve the quality of care and ultimately affect patient outcomes.

Acquired Immunodeficiency Syndrome↗