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Biomedical subjects

T Fulmer

Publications and source records attributed to T Fulmer.

At least 19 recordsLinked to original sources
PubMed2000

Engaging staff nurses in evidence-based research to identify nursing practice problems and solutions.

This article illustrates how one academic health science center in a large metropolitan area sought to improve the quality of patient care by soliciting the input of their nursing staff in devising an action plan for change. The research model incorporated both survey and focus group methods used by nursing leaders in administration and practice to identify and prioritize nursing research and clinical needs in their organization. The goal was to establish consensus among clinicians and researchers about significant issues in the institution requiring in-depth attention. A second objective was to design a survey instrument that is easy to complete and could be distributed, collected, and analyzed easily, thereby providing empirical data to the clinicians in a timely manner and in a simple format. This expedited process enabled specific action plans to be developed around the identified problems. Moreover, the process promoted interest in advancing nursing research and evidence-based practice among the clinicians and administrators.

Adult↗
PubMed2000

Elder neglect assessment in the emergency department.

INTRODUCTION: Emergency departments are often the first point of contact for elder neglect victims. The purpose of this article is to describe a pilot study pertaining to the screening of patients and detection of elder neglect conducted in a large metropolitan medical center emergency department. The research question to be answered was, "Is it feasible for ED nurses to conduct accurate screening protocols for elder neglect in the context of their busy practice?" METHODS: During a 3-week period, 180 patients older than age 70 years (90% of all possible elderly patients during the screening hours) were screened to determine if they met the study criteria and could be enrolled into the protocol. RESULTS: Thirty-six patients met the eligibility criteria to enroll in the study, and 7 patients screened positive for neglect by a home caregiver. The nurses were able to screen and detect elder neglect with more than 70% accuracy, confirming the research question. The true-positive rate was 71%, and the false-positive rate was 7%. DISCUSSION: Elder neglect protocols are feasible in busy emergency departments, and neglect can be accurately detected in the emergency department when screening procedures are in place.

Aged↗
PubMed2000

Enhancing geriatric nursing scholarship: specialization versus generalization.

This article explores the relative merits of encouraging preparation of more nurses with specialization in geriatrics as compared to encouraging geriatric preparation among nurses whose major field of study is outside geriatrics. The article explores two approaches to examining capacity for geriatric nursing scholarship among nurse scholars not involved in geriatrics, and in schools of nursing with strength in research but with little geriatric research. The findings show an ongoing need to strengthen geriatric nursing as an area of specialization. Faculty prepared in geriatric nursing are underrepresented in schools of nursing, and only a small number of doctoral students specialize in geriatric nursing. Academic nursing programs with strength in geriatric nursing need ongoing support to maintain and expand current geriatric programs. Data support that encouraging individual non-geriatric nurse faculty and doctoral candidates to focus their work on areas of concern to geriatric nursing, and strengthening geriatrics in research-intensive schools of nursing that have not heavily invested in geriatric scholarship are viable options for strengthening academic geriatric nursing. Establishing mechanisms to attract nurse scholars working outside the scope of geriatric nursing to address clinical issues of concern to older adults offers promise in rapidly attracting new scholars to geriatric nursing.

Adult↗
PubMed1999

A health information network for managing innercity tuberculosis: bridging clinical care, public health, and home care.

The purpose of this study was to use a health information network and innovative technology to coordinate tuberculosis care. An innercity medical center, a local health department, and a home care nurse service in northern Manhattan were used. The organizations were linked with computer networks. An automated decision support system with a natural language processor was used to detect tuberculosis cases and report them to the health department, and to select patients for respiratory isolation. Educational materials were placed on the World Wide Web and a Web-based kiosk. Home care nurses were outfitted with wireless pen-based computers, and data were relayed to the medical center. Automated tuberculosis case reporting resulted in time savings but not improved accuracy. Automated rules resulted in significant improvements in respiratory isolation. Kiosk educational materials were well-used. Wireless computing led to better access to information for both nurses and physicians, but not to reduction of workload. The key success element was recognition of critical priorities. It is concluded that innovative technology can facilitate the coordination of clinical care, public health, and home care.

Academic Medical Centers↗
PubMed1998

Home health nurses' initial experiences with wireless, pen-based computing.

Eight home health nurses from the Visiting Nurse Service of New York participated in a focus group discussion after their initial experiences using wireless, pen-based computing in the inner-city, home care environment. Transcripts of the nurses' responses to open-ended questions were analyzed and central themes were found, following the method of concept analysis described by Strauss and Corbin (1990). The central concepts were "Readiness," "A thousand pounds on my back," "Call for support," "Problems with transmission," "Using the computer as an assistant," "Nurses discovered glitches," and "Everybody has to have a computer." These themes reflected the nurses' initial experiences with the wireless computers and also revealed their concerns. This article will describe these themes and will discuss the implications of current improvements in wireless computing for health care. The focus group themes aided in understanding how this group of experienced home health nurses began to transition from handwriting on several different forms to checking-off items on a small, hand-held computer screen, from innovating methods to communicate when telephones were not available, to using a wireless computer to send and receive data involved in the patient admission process

Attitude of Health Personnel↗
PubMed1998

Rethinking geriatric nursing.

Geriatric nursing has radically progressed in the past 2 decades, moving from a custodial approach, to one that is anticipatory, evidenced-based, and proactive. This article provides a brief overview on the new thinking that is shaping geriatric nursing practice. Active interventions are discussed within the interdisciplinary mandate.

Aged↗
PubMed1998

Neglect in the elderly patient.

This article provides a brief overview of elder mistreatment, and then focuses on the major problem of elder neglect. Neglect is the most prevalent and least well understood component of elder mistreatment, and it is crucial that nurses who work with older people gain a better understanding of this problem. The article also presents models for understanding the problem, as well as provides recommendations for practice.

Aged↗
PubMed1997

Evaluating the caregiver's intervention in the elder's task performance: capacity versus actual behavior.

As an elder's functional impairment increases, so in general does the tendency for the caregiver to intervene in the elder's daily activities and initiatives. To a certain extent, such intervention is necessary to compensate for the elder's loss of independent ability, and without such intervention, adverse outcomes for the elder are a possibility. The need for some intervention is usually clear-cut for advanced dementia, given its associated severe disability and handicap, but less clear in elders who are just beginning to show signs of cognitive decline. This study used the paradigm of medication management to look at whether the discrepancy between capacity for self-medication administration and actual self-administration behavior as demonstrated by the Medication Management Test (MMT) is greater for elders with poorer cognitive functioning. A sample of 51 cognitively impaired elders and 74 cognitively normal elders was used to look at the relationship between predicted capacity and actual self-administration of medication, stratifying by level of cognitive status. The highly significant concordance between the MMT score and caregivers' report of medication administration supports the expectation that capacity is influenced by cognitive status. In those discordant cases, further information is needed to interpret help in medication administration as excessive or insufficient intervention.

Aged↗
PubMed1997

Introduction of wireless, pen-based computing among visiting nurses in the inner city: a qualitative study.

The purpose of this qualitative study is to understand how a sample of visiting nurses experienced the practice of home health nursing in the inner city and how they perceived the anticipated introduction of wireless, pen-based computing into their practice. Focus groups were held with visiting nurses 1 week before the introduction of the wireless, pen-based computers. The data were analyzed using Strauss and Corbin's (1990) method for concept development. The following central concepts emerged from the focus groups with visiting nurses: "Missing contact in the field," "Consumption of time writing on forms," "Using the computer to help with the practice of home health nursing," and "Home nursing is a lifeline." These concepts, based on the commentaries by visiting nurses, help one to understand the problems encountered by visiting nurses in the delivery of home health care, identify ways to incorporate evolving technologies to enhance nursing practice, and consider approaches to computer skill acquisition.

Community Health Nursing↗