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Clinical nursing judgment related to reducing the incidence of falls by elderly patients.

The incidence of falls among elderly patients has been and continues to be a major challenge for nurses. Falls add physical injury and mental stress to patients' existing health problems, are a deterrent to rehabilitation, and increase healthcare costs. This study describes the variables that nurses identify as influencing their clinical decision making and the nursing behaviors associated with preventing patient falls. The study was grounded in the theory that discretionary nursing behaviors are related to nursing expertise, and the study was guided by the assumption that such behaviors are proactive and anticipatory. An analysis of interviews of registered nurses (n = 14) working on a geriatric rehabilitation unit in a medical center in Ohio focused on the zones of association and the contextual meanings of language used by the nurses when discussing patient falls. Four themes emerged: the reasons for patient falls, identifying patients who are likely to fall, preventing falls, and nurses' feelings when patients fall.

Accidental Falls↗

Why does monitoring fail in jargon aphasia? comprehension, judgment, and therapy evidence.

Many people with jargon aphasia seem unaware of their speech disorder. The first section of this paper reports data from four subjects which indicate that self-monitoring can fail even when subjects' input skills are apparently adequate to detect their errors. Explanations for this dissociation have attributed monitoring failure to a deficit in auditory feedback, or to a resource limitation which prevents concurrent speaking and monitoring. Section 2 reports a series of naming and judging experiments with one of the subjects which rule out these explanations. These show that the subject can detect his neologisms when he is repeating, but not when he is naming. These results suggest that his monitoring difficulties arise when he is accessing phonology from semantics. Section 3 presents a study which supports this inference, since it shows that semantically focused intervention yields improvements in self-monitoring. It is concluded (1) that monitoring failure can arise from deficits within the production process which preclude comparison of actual with intended output, and (2) that this deficit is best explained within a connectionist model in which monitoring is performed by feedback mechanisms in the word production process.

Aged↗

Experimental evidence for serial models of lexical access: a judgment task.

The hypothesis that the lemma and lexeme levels of lexical access are in a feed-forward serial relation is supported. Subjects judge the degree of semantic relatedness of pairs of words. Stimuli are all functionally synonymous; they are pairs of words implicated in natural word blends. Half the stimuli are phonologically related and the other half are not. In one experiment the pairs are presented in a sentential context and in the other no context is provided. In both the experiments the phonologically unrelated pairs are judged closer in meaning than the phonologically related pairs. This is interpreted as support for serial models of lexical access.

Cognition↗

Modeling unconscious gender bias in fame judgments: finding the proper branch of the correct (multinomial) tree.

In the preceding article, Buchner and Wippich used a guessing-corrected, multinomial process-dissociation analysis to test whether a gender bias in fame judgements reported by Banaji and Greenwald (Journal of Personality and Social Psychology, 1995, 68, 181-198) was unconscious. In their two experiments, Buchner and Wippich found no evidence for unconscious mediation of this gender bias. Their conclusion can be questioned by noting that (a) the gender difference in familiarity of previously seen names that Buchner and Wippich modeled was different from the gender difference in criterion for fame judgements reported by Banaji and Greenwald, (b) the assumptions of Buchner and Wippich's multinomial model excluded processes that are plausibly involved in the fame judgement task, and (c) the constructs of Buchner and Wippich's model that corresponded most closely to Banaji and Greenwald's gender-bias interpretation were formulated so as to preclude the possibility of modeling that interpretation. Perhaps a more complex multinomial model can model the Banaji and Greenwald interpretation.

Female↗

Affective judgments of faces modulate early activity (approximately 160 ms) within the fusiform gyri.

Functional neuroimaging studies have implicated the fusiform gyri (FG) in structural encoding of faces, while event-related potential (ERP) and magnetoencephalography studies have shown that such encoding occurs approximately 170 ms poststimulus. Behavioral and functional neuroimaging studies suggest that processes involved in face recognition may be strongly modulated by socially relevant information conveyed by faces. To test the hypothesis that affective information indeed modulates early stages of face processing, ERPs were recorded to individually assessed liked, neutral, and disliked faces and checkerboard-reversal stimuli. At the N170 latency, the cortical three-dimensional distribution of current density was computed in stereotactic space using a tomographic source localization technique. Mean activity was extracted from the FG, defined by structure-probability maps, and a meta-cluster delineated by the coordinates of the voxel with the strongest face-sensitive response from five published functional magnetic resonance imaging studies. In the FG, approximately 160 ms poststimulus, liked faces elicited stronger activation than disliked and neutral faces and checkerboard-reversal stimuli. Further, confirming recent results, affect-modulated brain electrical activity started very early in the human brain (approximately 112 ms). These findings suggest that affective features conveyed by faces modulate structural face encoding. Behavioral results from an independent study revealed that the stimuli were not biased toward particular facial expressions and confirmed that liked faces were rated as more attractive. Increased FG activation for liked faces may thus be interpreted as reflecting enhanced attention due to their saliency.

Adult↗

Systematic errors in medical decision making: judgment limitations.

Much of medical practice involves the exercise of such basic cognitive tasks as estimating probabilities and synthesizing information. Scientists studying cognitive processes have identified impediments to accurate performance on these tasks. Together the impediments foster "cognitive bias." Five factors that can detract from accurate probability estimation and three that impair accurate information synthesis are discussed. Examples of all eight factors are illustrated by reference to published articles. The authors suggest ways to minimize the negative influences of these factors.

Cognition↗