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Biomedical subjects

S B Henry

Publications and source records attributed to S B Henry.

At least 55 records · Page 3Linked to original sources
PubMed1991

Clinical decision making of critical care nurses managing computer-simulated tachydysrhythmias.

The purposes of this study were to describe the clinical decision making of critical care nurses managing computer-simulated tachydysrhythmias and to assess the major sources of error related to the management of two tachydysrhythmias: atrial flutter and ventricular tachycardia. In this descriptive study, 142 critical care nurses each completed four computerized clinical simulations (two atrial flutter and two ventricular tachycardia). Simulation performance was measured by proficiency score (comparison with expert performance), patient outcome (cure or die), and amount of data collected before the first intervention. Mean proficiency scores were 51% for atrial flutter and 35% for ventricular tachycardia. Thirteen percent of the atrial flutter and 35% of the ventricular tachycardia simulations ended in patient death. Failure to recognize ventricular tachycardia and unfamiliarity with second- and third-line treatments were major sources of error. Medication errors were the cause of death in 87% of the simulations ending in patient death. These results document the need for emphasis on dysrhythmia management in the critical care curriculum.

Arrhythmias, Cardiac↗
PubMed1991

Effect of level of patient acuity on clinical decision making of critical care nurses with varying levels of knowledge and experience.

This study is an examination of the effect of patient acuity on the clinical decision making of critical care nurses (N = 68) completing two computerized clinical simulations. Ventricular tachycardia represented the high-acuity situation and atrial flutter the lower-acuity situation. Clinical decision making was measured by proficiency score, patient outcome (cure or die), and amount of data collected. Analyses of variance were conducted to examine proficiency score and the amount of data collected. Fisher's exact test and the McNemar test of homogeneity of proportions were used to examine patient outcome. In the atrial flutter simulation, proficiency scores were higher (p = 0.000), more dysrhythmias were cured (p less than 0.005), and more data were collected (p = 0.040). Experienced and inexperienced nurses did not differ on proficiency score; however, inexperienced nurses collected more data (p = 0.048) and cured fewer atrial flutter simulations (p = 0.040). Nurses certified in advanced cardiac life support had higher proficiency scores (p = 0.033) and collected fewer data (p = 0.048).

Acute Disease↗
PubMed1989

The effect of verbalization of cognitive processes on clinical decision making.

Although verbalization of cognitive processes is a common strategy in the study of clinical decision making, the effect of verbalization on performance has not been adequately assessed. The effect of verbalization of cognitive processes on performance on a computer-assisted clinical simulation was examined using a three-group experimental design. Sixty pediatric nurses were randomly assigned to one of three groups (n = 20/group): instructions to think aloud, instructions to recall decision processes, or no instructions to verbalize. The experimental groups did not differ on proficiency or efficiency scores on the computerized clinical simulation. Two-way analyses of variances revealed no main or interaction effects when examining type of verbalization instructions by level of education, years of pediatric experience, or case familiarity, suggesting that there was no apparent effect of verbalization of cognitive processes on performance regardless of level of expertise. These findings support the continued use of verbalization of cognitive processes as a strategy to examine clinical decision making.

Clinical Competence↗
PubMedDate not supplied

Quality of life and self-care management strategies of PLWAs with chronic diarrhea.

A case control design was used to examine quality of life and self-care management strategies in persons living with AIDS (PLWAs) with chronic diarrhea. PLWAs without chronic diarrhea (n = 20) as compared to those with chronic diarrhea (n = 20) reported significantly higher general health perceptions (p = .028). In contrast, comparisons on symptom status scores revealed that PLWAs without chronic diarrhea reported greater fatigue (p = .05), greater psychological distress (p = .005), and greater gastrointestinal discomfort (p = .01). Although the intensity of chronic diarrhea was reported as moderate to severe by 85% of the sample, no single category of self-care management strategies was used by more than 65% of respondents. The number of categories of self-care management activities was significantly correlated with general health perceptions. The study findings support the need to test nursing interventions aimed at improving symptom management in chronic diarrhea and facilitating self-care behaviors including those focused on increasing adherence to prescribed therapeutic regimens.

Adaptation, Psychological↗
PubMedDate not supplied

The Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention for enhancing adherence to HIV/AIDS medications: a pilot study.

This article describes the Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention designed to enhance adherence to HIV/AIDS medications and reports the results of a pilot study aimed at assessing the feasibility of CAP-IT. Initially, CAP-IT was designed to be implemented by nurse case managers during regularly scheduled home visits; it is currently under revision for use in an outpatient, ambulatory care setting. CAP-IT is an innovative, structured nursing assessment and care-planning activity that allows a standardized assessment of client needs and tailored highly active antiretroviral therapy adherence intervention strategies. CAP-IT is significantly different from the current standard nursing case management practice. Pilot study results in a sample of 10 home care patients suggests that clients have knowledge and skill deficits related to adherence and in the management of the side effects of medications. In addition, the pilot study supported the acceptability of the protocol to clients and the feasibility of integrating CAP-IT into nurse case manager practice. The pilot study results also provided evidence for the efficacy of CAP-IT. The next steps include testing CAP-IT in a randomized clinical trial to determine its effectiveness.

Adult↗
PubMedDate not supplied

Problems of persons with HIV/AIDS hospitalized for Pneumocystis carinii pneumonia.

The authors of this prospective study describe the problems of persons living with HIV/AIDS hospitalized for Pneumocystis carinii pneumonia (PCP) (N = 90) and examine how the problems change over time. Data were obtained from four sources and were classified into major problem categories. The largest mean number of problems were reported in the category of PCP. Specific psychosocial problems were more likely to be reported in the patient and nurse interviews than in the chart and intershift report. The study findings validate the physical symptoms addressed in the published care plans and guidelines for caring for patients with PCP. The study identified the limitation of using the patient record as the only data source in determining nursing care needs and emphasized the importance of the patients perspective.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Assessing and managing pain in AIDS care: the patient perspective.

Although the prevalence and complexity of pain management in HIV/AIDS has been described in the literature, little is known about the management of pain from the patient perspective. This study used a set of standardized instruments, a medication chart audit, and a semistructured interview to elicit patients' self-reports of pain and patients' perceptions of nursing and self-care pain management strategies and examined potential physiological and psychosocial correlates of pain. The sample of 249 AIDS patients from three types of care settings (hospital, home care, skilled nursing facility) reported a modest overall current pain intensity (M = .14, range = 0-1). They reported experiencing pain in all body parts as measured by a body outline and characterized their pain with an average of 8.96 words from a list of 67 words. A lower pain rating was correlated with higher ratings on quality of life and perceived psychological support. An audit of the medication record revealed that the study sample received the following medications: narcotic analgesics (49%), nonnarcotic analgesics (47%), and antidepressants (22%). In a semistructured interview, medications were rated as effective by 80% of patients experiencing pain who stated that their health care providers included pain medications as part of the patient's pain management plan. Patients reported few nonpharmacologic self-care or health care provider interventions to manage their pain, and the effectiveness ratings of the interventions demonstrated wide variability. The study findings suggest that because pain was related to quality of life ratings and the pain management strategies reported by patients were not completely effective, further work is needed to examine pain management strategies that incorporate both pharmacologic and nonpharmacologic interventions with particular attention to self-care interventions. In addition, the data suggest that nursing assessments should include questions aimed at eliciting potentially harmful (e.g., street drugs, self-prescribed medications) strategies that patients may be using to manage their pain.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The ICNP's relevance in the US.

Efforts to develop an International Classification for Nursing Practice (ICNP) were initiated nearly a decade ago. To update nurses on progress, below is a critical review of the ICNP using the Computer-based Patient Record Institute (CPRI) Features Framework and a discussion of its relevance to current US efforts: 1) the activities of the American Nurses' Association (ANA) Steering Committee on Databases To Support Clinical Nursing Practice; 2) implementation of formal approaches for representing nursing concepts and 3) Health Level 7 standards.

American Nurses' Association↗
PubMedDate not supplied

A comparison of patient and nurse ratings of human immunodeficiency virus-related signs and symptoms.

Since management strategies are guided by the assessment of the symptom experience, agreement between patients' and nurses' perceptions of symptoms is central to clinical management. In this study, acquired immune deficiency syndrome patients' perceptions of 41 human immunodeficiency virus-related signs and symptoms were compared in 207 pairs of ratings by patients (n = 207) and nurses (n = 103). Ten symptoms were reported by 50% or more of the patients. Mean patient intensity ratings for all signs and symptoms, with the exception of anxiety, were higher than nurse ratings. Using patients' ratings as the gold standard, chance-corrected estimates of sensitivity, specificity, positive predictive value, and negative predictive value of the nurses' ratings suggested that nurses' ratings poorly predicted patients' symptom experiences.

Adult↗
PubMedDate not supplied

Terms used by nurses to describe patient problems: can SNOMED III represent nursing concepts in the patient record?

OBJECTIVE: To analyze the terms used by nurses in a variety of data sources and to test the feasibility of using SNOMED III to represent nursing terms. DESIGN: Prospective research design with manual matching of terms to the SNOMED III vocabulary. MEASUREMENTS: The terms used by nurses to describe patient problems during 485 episodes of care for 201 patients hospitalized for Pneumocystis carinii pneumonia were identified. Problems from four data sources (nurse interview, intershift report, nursing care plan, and nurse progress note/flowsheet) were classified based on the substantive area of the problem and on the terminology used to describe the problem. A test subset of the 25 most frequently used terms from the two written data sources (nursing care plan and nurse progress note/flowsheet) were manually matched to SNOMED III terms to test the feasibility of using that existing vocabulary to represent nursing terms. RESULTS: Nurses most frequently described patient problems as signs/symptoms in the verbal nurse interview and intershift report. In the written data sources, problems were recorded as North American Nursing Diagnosis Association (NANDA) terms and signs/symptoms with similar frequencies. Of the nursing terms in the test subset, 69% were represented using one or more SNOMED III terms.

Delivery of Health Care↗
PubMedDate not supplied

Informatics: essential infrastructure for quality assessment and improvement in nursing.

In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is supported by 1) presentation of a historical perspective on quality assessment and improvement; 2) delineation of the types of data required for quality assessment and improvement; and 3) description of the current and potential uses of information technology in the acquisition, storage, transformation, and presentation of quality data, information, and knowledge.

Computer Communication Networks↗
PubMedDate not supplied

Nursing classification systems: necessary but not sufficient for representing "what nurses do" for inclusion in computer-based patient record systems.

Our premise is that from the perspective of maximum flexibility of data usage by computer-based record (CPR) systems, existing nursing classification systems are necessary, but not sufficient, for representing important aspects of "what nurses do." In particular, we have focused our attention on those classification systems that represent nurses' clinical activities through the abstraction of activities into categories of nursing interventions. In this theoretical paper, we argue that taxonomic, combinatorial vocabularies capable of coding atomic-level nursing activities are required to effectively capture in a reproducible and reversible manner the clinical decisions and actions of nurses, and that, without such vocabularies and associated grammars, potentially important clinical process data is lost during the encoding process. Existing nursing intervention classification systems do not fulfill these criteria. As background to our argument, we first present an overview of the content, methods, and evaluation criteria used in previous studies whose focus has been to evaluate the effectiveness of existing coding and classification systems. Next, using the Ingenerf typology of taxonomic vocabularies, we categorize the formal type and structure of three existing nursing intervention classification system--Nursing Interventions Classification, Omaha System, and Home Health Care Classification. Third, we use records from home care patients to show examples of lossy data transformation, the loss of potentially significant atomic data, resulting from encoding using each of the three systems. Last, we provide an example of the application of a formal representation methodology (conceptual graphs) which we believe could be used as a model to build the required combinatorial, taxonomic vocabulary for representing nursing interventions.

Abstracting and Indexing↗
PubMedDate not supplied

A template-based approach to support utilization of clinical practice guidelines within an electronic health record.

Practice guidelines are an integral part of evidence-based health care delivery. When the authors decided to install the clinical documentation component of an electronic health record in a nurse practitioner faculty practice, however, they found that they lacked the resources to integrate it immediately with other systems and components that would support the processing of clinical rules. They were thus challenged to devise an initial approach for decision support related to clinical practice guidelines that did not include interfacing with an inference engine and set of decision rules. The authors developed a prototypic application within the WAVE electronic health record that demonstrates the feasibility of representing a guideline as structured encoded text organized into an online patient-encounter template. Although this approach may be more broadly applicable, it is described within the context of the management of diabetes mellitus by nurse practitioners. The advantages of the approach relate primarily to the integration of the guideline recommendations with the encounter form, the online interaction of the clinician with the system, and the ease of creation and modification of the guideline-based encounter form. However, there are several limitations of the current approach as a result of the inability to do inference and the lack of integration with patient-specific data to trigger specific rules.

Decision Support Systems, Clinical↗
PubMedDate not supplied

A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems.

Building on the work of previous authors, the Computer-based Patient Record Institute (CPRI) Work Group on Codes and Structures has described features of a classification scheme for implementation within a computer-based patient record. The authors of the current study reviewed the evaluation literature related to six major nursing vocabularies (the North American Nursing Diagnosis Association Taxonomy 1, the Nursing Interventions Classification, the Nursing Outcomes Classification, the Home Health Care Classification, the Omaha System, and the International Classification for Nursing Practice) to determine the extent to which the vocabularies include the CPRI features. None of the vocabularies met all criteria. The Omaha System, Home Health Care Classification, and International Classification for Nursing Practice each included five features. Criteria not fully met by any systems were clear and non-redundant representation of concepts, administrative cross-references, syntax and grammar, synonyms, uncertainty, context-free identifiers, and language independence.

Evaluation Studies as Topic↗
PubMedDate not supplied

Computer-supported versus manually-generated nursing care plans: a comparison of patient problems, nursing interventions, and AIDS patient outcomes.

The number and type of activated patient problems and the number of nursing interventions in computer-supported and manually-generated nursing care plans for Human Immunodeficiency Virus (HIV) infected patients hospitalized for Pneumocystis carinii pneumonia (PCP) were compared. There were significantly more activated patient problems (p = 0.005) and nursing interventions (p = 0.002) listed using the computer-supported care planning system. The top ranked problems in both systems were reflective of the clinical presentation of acute PCP. The problem, potential for increased risk of infection, was activated more frequently using the computer-supported care plan. There were no significant differences in patient outcome as measured by functional status and patients' self-ratings of physical condition at hospital discharge.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

An inductive algorithm approach to knowledge acquisition for expert system development. A pilot study.

Knowledge acquisition, which consists of knowledge elicitation and knowledge representation, often is considered the weakest link in the design of expert systems. Systems frequently are built on the knowledge of one expert and require extensive use of knowledge engineering techniques to elicit this knowledge from the expert. Inductive algorithms are a potential alternative method of knowledge acquisition for expert system development. The aim of this pilot study was to examine the feasibility of applying machine learning techniques, specifically, inductive algorithms, to an existing research database as a method for knowledge elicitation and knowledge representation for expert system development. Two inductive algorithms (C4 and Classification and Regression Trees [CART]) that generate decision trees were selected for the analysis using a data set of 201 patients hospitalized for Pneumocystis carinii pneumonia. Neither C4 nor CART produced trees with an accuracy that was significantly better than the baseline accuracy (71.3%) for prediction of outcome in the data set. The mean accuracy of the C4 decision trees was below baseline and the mean accuracy of CART decision trees was 74.6%. The experts found both algorithms comprehensible, but not adequate, and identified important missing predictor variables. The study findings suggest that additional research is needed to examine the appropriate use of inductive algorithms in the transformation of nursing data and information into nursing knowledge.

Algorithms↗