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PubMedDate not supplied

Standards for nursing terminology.

Terminology work in nursing has given rise to an increasing number of nursing terminologies. These generally take the form of controlled vocabularies. Because of the limitations of the controlled vocabulary approach, individual terminologies tend to be tuned to meet the specific needs of their intended users. Differences between terminologies are now a significant barrier to the comparison and interchange of health information. To agree on a single, multipurpose terminology would be problematic. However, several options for resolving unnecessary differences between nursing terminologies are currently being explored by international standards bodies and other groups, such as the U.S. Nursing Vocabulary Summit. One such option is the use of a terminology model to facilitate evolution toward a more coherent range of terminologies. The authors describe the motivation behind the development of a standard for nursing terminologies. They explain how a terminology model might form the basis for such a standard through a description of the approach taken by CEN TC251 (the Health Informatics Technical Committee of the European Committee for Standardization). They also discuss possible limitations of standardization.

Nursing↗
PubMedDate not supplied

Toward national comparable nurse practitioner data: proposed data elements, rationale, and methods.

Federal funds have supported Nurse Practitioner (NP) education and the establishment of nurse-managed centers. Yet, important questions are raised about the quality and appropriate scope of NP care. Few NP-patient encounters are documented in the largest national surveys of ambulatory care, sponsored by the National Center for Health Statistics, due to sampling frames that are based on physician practices. In addition, these national surveys lack essential outcome indicators, therefore limiting their data to descriptions of patient demographics and practice patterns. Informatics principles are applied to a proposed expansion of the National Ambulatory Medical Care Survey. Its sample would include nurse-managed centers and its variables would include quality outcome and process indicators in standardized language that are nurse-sensitive and that reflect national priorities for action on health care quality. Variables for inclusion in a draft pilot instrument are identified.

Ambulatory Care↗
PubMedDate not supplied

Using the Internet to teach health informatics: a case study.

BACKGROUND: It is becoming increasingly important for health professionals to have an understanding of health informatics. Education in this area must support not only undergraduate students but also the many workers who graduated before informatics education was available in the undergraduate program. To be successful, such a program must allow currently-employed students with significant work and family commitments to enroll. OBJECTIVES: The aim was to successfully create and teach a distance program in health informatics for the New Zealand environment. METHODS: Our students are primarily health professionals in full time employment. About 50% are doctors, about 25% nurses, and the rest include dentists, physiotherapists, and medical managers. Course material was delivered via the World Wide Web and CD-ROM. Communication between students and faculty, both synchronous and asynchronous, was carried out via the Internet. RESULTS: We have designed and taught a postgraduate Diploma of Health Informatics program using the Internet as a major communication medium. The course has been running since July 1998 and the first 10 students graduated in July 2000. About 45 students are currently enrolled in the course; we have had a dropout rate of 15% and a failure rate of 5%. Comparable dropout figures are hard to obtain, but a recent review has suggested that failure-to-complete rates of 30% to 33% may be expected. CONCLUSIONS: Internet technology has provided an exciting educational challenge and opportunity. Providing a web-based health informatics course has not been without its frustrations and problems, including software compatibility issues, bandwidth limitations, and the rapid change in software and hardware. Despite these challenges, the use of Internet technology has been interesting for both staff and students, and a worthwhile alternative for delivering educational material and advice to students working from their own homes.

Education, Distance↗
PubMed1998

Determinants of microcomputer technology use: implications for education and training of health staff.

In hospitals and other Healthcare settings, increasingly, hands-on computer use is becoming an important behaviour for effective job performance. The literature has identified differences that relate to computer use between occupational categories in health services. The objectives of this study were to identify factors that determine computer acceptance among occupational groups in Community Health and to predict the factors that relate to computer use. A survey was administered to all Community Health staff in one health service area. Health administrators were found to have a significantly higher training in computers, a higher frequency of use and a higher level of skill for both applications (word processing (WP) and database (DB)) than nurses. The results of a regression analysis shows that about 55% of the variation in the use of WP is explained by computer skills, perceived usefulness (PU) and designation. In the case of DB use, PU was the only significant predictor explaining 53% of the variation. Both level of education and prior training were not significant predictors. The implication for health informatics education (and service training) of these findings is that, in the workplace, health professionals would use computers when they perceive it to be useful for performance in their jobs.

Administrative Personnel↗
PubMedDate not supplied

Combining estimates from complementary surveys: a case study using prevalence estimates from national health surveys of households and nursing homes.

OBJECTIVES: When a single survey does not cover a domain of interest, estimates from two or more complementary surveys can be combined to extend coverage. The purposes of this article are to discuss and demonstrate the benefits of combining estimates from complementary surveys and to provide a catalog of the analytic issues involved. METHODS: The authors present a case study in which data from the National Health Interview Survey and the National Nursing Home Survey were combined to obtain prevalence estimates for several chronic health conditions for the years 1985, 1995, and 1997. The combined prevalences were estimated by ratio estimation, and the associated variances were estimated by Taylor linearization. The survey weights, stratification, and clustering were reflected in the estimation procedures. RESULTS: In the case study, for the age group of 65 and older, the combined prevalence estimates for households and nursing homes are close to those for households alone. For the age group of 85 and older, however, the combined estimates are sometimes substantially different from the household estimates. Such differences are seen both for estimates within a single year and for estimates of trends across years. CONCLUSIONS: Several general issues regarding comparability arise when there is a goal of combining complementary survey data. As illustrated by this case study, combining estimates can be very useful for improving coverage and avoiding misleading conclusions.

Aged↗
PubMedDate not supplied

Use of a pregnancy support web site by low-income African American women.

OBJECTIVE: To examine the feasibility and usage pattern of a social support Web site by low-income pregnant African American women. DESIGN: Descriptive. SETTING: Homes of participants. PARTICIPANTS: Nineteen pregnant African American women who were pregnant for the first time, were low risk, and attending a prenatal clinic. INTERVENTION: Culturally congruent Web site providing information on pregnancy-related health behaviors and other pregnancy issues. MAIN OUTCOME MEASURES: Number of visits to Web site, most popular pages, content analysis of postings, and e-mails to a nurse. RESULTS: Participants were able to learn to use the Web site easily. They accessed the discussion board the most frequently, followed by changes during pregnancy by month, ask-a-nurse feature, ultrasound, stories about pregnant women, and spirituality. CONCLUSIONS: The discussion board is the most effective way to deliver informational social support on a comprehensive social support Web site.

Adolescent↗
PubMed2006

Towards a hybrid method to categorize interruptions and activities in healthcare.

OBJECTIVE: Interruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper, a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular as well as improving healthcare quality and patient safety in general. METHOD: The hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory. RESULTS: The categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case. CONCLUSIONS: Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

Communication↗
PubMed1992

A survey of videodisc and interactive videodisc projects in North America: Part I.

Selected videodisc (VD) and interactive videodisc (IVD) programs, projects and topics are presented in two articles in this and a subsequent issue of the journal. Part I reviews the impact of Information Science developments on image management. The American Society of Hematology Slide Bank and other specific applications in urology, paediatric neurology, obstetrical nursing, medical decision making, dental diagnosis and treatment (DDT), and paediatric cardiology, are reviewed as educational and informatics research projects. This is followed by a section on three-dimensional reconstructions of the brain which stresses digital images. Multi-purposing and repurposing are reviewed in two prototype programs. A discussion of the multidisciplinary Slice of Life projects completes this first article.

Computer Graphics↗
PubMed1993

Selecting an information system.

Use of new technology can improve productivity without compromising staff nurse time at the bedside. At Borgess Medical Center an interdisciplinary committee co-chaired by nurses analyzed the information system and documentation procedures and developed a plan approved by administration. This resulted in establishment of both a sophisticated point-of-care system and an ongoing patient care informatics committee to further coordinate automation throughout the hospital.

Computers↗
PubMedDate not supplied

Current and future models for nursing e-journals: making the most of the Web's potential.

We are presently witnessing an increasing number of nursing, medical and health-related electronic journals (e-journals) being made available on the World Wide Web, a minority of which are specifically devoted to informatics. We would expect, given the potential of interacting multimedia and computer-mediated communications (i.e. telematics), to also see an increasing diversity of models, but this is not currently the case. Following a brief discussion of some of the issues relevant to electronic publications, the authors present a taxonomy of current nursing e-journal models, including discussion of some examples from around the world that fall into categories within this taxonomy. We describe the model and levels of usage of one particular e-journal, Nursing Standard Online. Some of the issues presented may account for the current relative paucity of high quality content and innovative models in the development of Web-based e-journals for nurses and other health professionals. We believe it likely that nursing e-journals using current models will need to be specialist rather than generalist if they are to attract a larger audience. In concluding our paper, we advocate the development of innovative and increasingly interactive nursing e-journals as the way forward, discussing one particular model which holds promise.

Classification↗
PubMed2002

The historical role and education of nurses for the care and management of sexually transmitted infections in the United Kingdom: 2 education and training.

The beginning of the 20th century saw the first attempts to educate nurses about sexually transmitted infections (STIs) in the United Kingdom. Throughout the century, numerous individuals and organisations campaigned for improved STI awareness education for nurses. Education initiatives gradually moved from the more generic nurse training programmes to the specialist courses for genitourinary medicine (GUM) nurses. Even so, it wasn't until the 1970s that these specialist courses were successfully implemented and sustained. Following a detailed review of nursing education and STIs over the past century, this paper speculates why programmes of STI education have never been sustained for the general nursing workforce. It then considers possible developments for future education agendas that will ultimately enable nurses to contribute more readily to the challenges that national sexual health and nursing strategies currently propose.

Curriculum↗
PubMed2005

Linked analysis for definition of nurse advice line syndrome groups, and comparison to encounters.

INTRODUCTION: Nurse advice call centers are a potentially important source of data for syndromic surveillance purposes. For this reason, researchers at Johns Hopkins University Applied Physics Laboratory and Kaiser Permanente of the Mid-Atlantic States (KPMAS) have been collaborating to develop methods to use this data within the ESSENCE II Syndromic Surveillance System in the National Capital Region. OBJECTIVE: The objective of this report is to present a general method for finding syndrome groups in data sources that can be linked to physician encounters and to determine effective advice call syndrome groups for use with KPMAS advice data. METHODS: Advice calls are linked to physician encounters and stratified by patient age. They are placed in groups according to a maximum positive predictive value criterion. The groups are evaluated by correlating the resulting syndrome time series against physician encounter data. RESULTS: Potentially useful advice syndrome groups are found for respiratory, lower gastrointestinal (GI), and total GI syndromes for each age stratum. CONCLUSION: The time series of the advice data for respiratory, lower GI, and upper GI syndromes accurately predict the physician encounter time series for the corresponding syndromes for each age stratum.

Diagnosis-Related Groups↗
PubMed1996

Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals. A challenge to hospital leadership.

OBJECTIVE: To provide hospital leaders with strategic goals or actions likely to have a significant impact on antimicrobial resistance, outline outcome and process measures for evaluating progress toward each goal, describe potential barriers to success, and suggest countermeasures and novel improvement strategies. PARTICIPANTS: A multidisciplinary group of experts was drawn from the following areas: hospital epidemiology and infection control, infectious diseases (including graduate training programs), clinical practice (including nursing, surgery, internal medicine, and pediatrics), pharmacy, administration, quality improvement, appropriateness evaluation, behavior modification, practice guideline development, medical informatics, and outcomes research. Representatives from appropriate federal agencies, the Joint Commission on Accreditation of Healthcare Organizations, and the pharmaceutical industry also participated. EVIDENCE: Published literature, guidelines, expert opinion, and practical experience regarding efforts to improve antibiotic utilization and prevent and control the emergence and dissemination of antimicrobial-resistant microorganisms in hospitals. CONSENSUS PROCESS: Participants were divided into two quality improvement teams: one focusing on improving antimicrobial usage and the other on preventing and controlling transmission of resistant microorganisms. The teams modeled the process a hospital might use to develop and implement a strategic plan to combat antimicrobial resistance. CONCLUSIONS: Ten strategic goals and related process and outcome measures were agreed on. The five strategic goals to optimize antimicrobial use were as follows: optimizing antimicrobial prophylaxis for operative procedures; optimizing choice and duration of empiric therapy; improving antimicrobial prescribing by educational and administrative means; monitoring and providing feedback regarding antibiotic resistance; and defining and implementing health care delivery system guidelines for important types of antimicrobial use. The five strategic goals to detect, report, and prevent transmission of antimicrobial resistant organisms were as follows: to develop a system to recognize and report trends in antimicrobial resistance within the institution; develop a system to rapidly detect and report resistant microorganisms in individual patients and ensure a rapid response by caregivers; increase adherence to basic infection control policies and procedures; incorporate the detection, prevention, and control of antimicrobial resistance into institutional strategic goals and provide the required resources; and develop a plan for identifying, transferring, discharging, and readmitting patients colonized with specific antimicrobial-resistant pathogens.

Anti-Bacterial Agents↗
PubMed1997

Value-adding information: virtual conferencing, a telecommunication pathway to the future.

The information or digital age has turned information communication upside down and inside out. This article describes use of the Internet and World Wide Web information flow and communication for a virtual professional health national event, in Australia. The stored information and subsequent dialogue were available nationally and internationally, making the telecommunication conference a global one. Defined are the background, vision, and assumptions on which the conceptual conference structure was ultimately designed, implemented, and evaluated, including the implications for value-adding nursing information.

Australia↗