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Biomedical subjects

Cornelia M Ruland

Publications and source records attributed to Cornelia M Ruland.

16 recordsLinked to original sources
PubMed2006

Children as design partners in the development of a support system for children with cancer.

Children with cancer experience many symptoms and problems that often remain unreported and untreated. We therefore, developed PedsChoice, a support system for pediatric cancer symptom assessment and management to provide children with a "voice," and assist nurses and physicians to better address children's symptoms and problems in patient care. We used participatory design techniques where healthy children joined our design team. During this process we explored the role s healthy children can appropriately play to inform the design of a system for children with cancer and their contributions and limitations as participants in the design process. We found that healthy children can contribute considerably in the role as testers, informers and to some extent as partners. Children have very creative design ideas that can considerably improve the software. However, system development for seriously ill children also requires psychological and pedagogical insights and design and usability expertise. This limits the role children can play as full design partners.

Child↗
PubMed2006

Increasing the usability of nursing intervention classification in EHR's.

In this pilot study, we abstracted nursing interventions documented in cancer patients' records to analyze (1) which types of interventions that were documented and (2) to which degree these nursing interventions could be classified with the Nursing Intervention Classification (NIC). This study provides us with valuable information about the usability of NIC as a classification system for use in Electronic Health Record (EHR) systems.

Focus Groups↗
PubMed2006

Mapping nurses' natural language to oncology patients' symptom expressions.

Systems that integrate information from both the patients and health professionals require bi-directional term translation. We manually extracted nursing terms from 25 randomly selected cancer patients' charts that expressed symptoms and mapped these to a set of patient-oriented symptoms from a cancer support system. We found that 40% of the nursing terms were synonyms of patient expressions that could be mapped directly; however 38% of the nursing terms required a map to more than one patient expression. In this study, we gained an understanding of the link between nursing and patient language that is needed for future system development.

Humans↗
PubMed2006

Clinicians' perceived usefulness of a support system for patient-centered cancer care.

We investigated the perceived usefulness by 65 nurses and 12 physicians who had used CHOICE, a support system designed to improve patient-centred symptom management for cancer patients at the point of care. Two questionnaires addressed the following aspects: clinicians' usage patterns; ease of use; system ability to improve care planning, understanding of patients' perspectives, and patient-provider communication; attitudes towards patients' involvement in decision making about patient care; and perceived usefulness, defined as a system's ability to enhance work performance. The overall survey response rate was 78%. Clinicians reported that they had used information outputs provided by the CHOICE system on average 50% of the time, but nurses used them significantly more than physicians. The system received high ratings on all aspects of usefulness by both groups, but again, nurses provided consistently higher usefulness ratings than physicians did. There was a strong, significant correlation between patterns of use and perceived usefulness. There were no correlations between perceived usefulness and respondents' age, gender and clinical experience. Results confirm that the CHOICE system can successfully assist nurses and physicians to improve patient care for cancer patients in ongoing practice.

Adult↗
PubMed2005

Multiple predictors of health-related quality of life in early stage breast cancer. Data from a year follow-up study compared with the general population.

Prospective longitudinal health-related quality of life (QOL) data from 161 women newly diagnosed with breast cancer were compared to age-adjusted mean QOL scores from a general female population (n=949). In addition, multiple factors (demographic, personality trait, participation in treatment decision-making, information satisfaction, and medical data), which previous research has indicated affect the QOL of breast cancer patients, were simultaneously investigated in a multivariate model, in order to determine which of these variables have the strongest influence on QOL one year after surgery. QOL was evaluated with the EORTC QLQ-C30 at time of diagnosis, three- and 12-months postoperatively. Women with breast cancer scored significantly lower on emotional, cognitive, and social functioning (p < 0.01) at time of diagnosis compared to the general female population, and continued to score lower on cognitive (p=0.008) and social (p=0.009) functioning one-year after surgery. In addition to the initial QOL, breast conservation surgery was predictive of better physical functioning (p=0.01) and body image (p < 0.0001), while chemotherapy was predictive for poorer role functioning (p=0.01) one year after surgery. Dispositional optimism was predictive for better emotional (p=0.003) and social functioning (p=0.01) one year after surgery. At time of diagnosis and throughout the post-diagnosis period, dispositional optimism was associated with better QOL and fewer symptoms.

Aged↗
PubMed2005

Stability in optimism-pessimism in relation to bad news: a study of women with breast cancer.

In this study, we investigated the stability of optimism-pessimism in relation to receiving bad news (i.e., positive lymph nodes, more advanced cancer stage) after breast cancer surgery and in comparison to the stability of anxiety and depression level. The women (n = 165) completed the Life Orientation Test-Revised (Scheier, Carver, & Bridges, 1994) and the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) at time of diagnosis, 3 months, and 12 months after surgery. Overall, women's optimism-pessimism levels remained stable over the follow-up period whether they received bad news or not. In contrast, women's anxiety and depression level decreased significantly over the same time period with 1 exception. Women's level of depression remained fairly stable among those who received bad news. Optimism-pessimism appears to remain stable over situations as well as time and regardless of negative affects.

Adaptation, Psychological↗
PubMed2005

Challenges in presenting categories of symptoms in a home health care system for cancer patients.

We investigated how patients use a symptom selection tool developed for use within Web-CHOICE, an Internet-based support system for cancer patients. This tool allows patients to browse a classification system that includes over 100 symptoms and select the symptoms they experience under the appropriate category. During the design process it became apparent that this structure presents considerable challenges to patients. There is a need to: 1) provide more flexible views of symptom categories, 2) display relationships between symptoms, and 3) make use of limited screen space. The first phase of usability testing has also shown a need for better visualization tools for viewing the symptom classification.

Home Care Services↗
PubMed2004

Improving patient safety through informatics tools for shared decision making and risk communication.

This paper describes how informatics tools can support shared decision making and risk communication and thereby play an important role in enhancing patient safety. Using preference elicitation techniques and knowledge on risk communication, such tools can help patients understand their treatment options and associated short- and long-term benefits and risks, assist in the elicitation of patient preferences, and help patients and clinicians in making treatment choices with the highest likelihood of achieving desired patient outcomes. Important features of such tools are proposed, including: (1) Interactive tutorials to improve risk comprehension and prepare patients and clinicians for the decision making task; (2) choices between different presentation modes to meet patients' individual reading levels and presentation preferences; (3) risk calculations that account for individual risk profiles; (4) performance of necessary calculations to reach the actual decision; (5) automatic updates of evidence; and (6) the use of different preference-elicitation techniques.

Decision Making, Computer-Assisted↗
PubMed2004

A survey about the usefulness of computerized systems to support illness management in clinical practice.

PURPOSE: This survey among an interdisciplinary group of clinicians was conducted to obtain their opinions about the usefulness of decision support systems (DSS) for evidence- and patient preference-based illness management, factors important to their implementation, and criteria for evaluating their effectiveness. METHODS: A questionnaire was sent by mail or electronically to a convenience sample of 184 nurses, physicians and other health care professionals. RESULTS: The DSS ability to provide information about potential benefits and harms of intervention options and reports on patient outcomes of symptom relief, functional status and preference achievement was considered most useful among DSS features. Nurses rated the usefulness of the DSS higher than physicians did. Ease of use, no increase in workload, and timely, precise information were rated as the most important factors for successful implementation. The most frequently selected patient, care process/provider and system outcomes rated as indicators for DSS effectiveness were: patient satisfaction, health-related quality of life, symptom relief, functional status, and alignment of patient preferences with realistic expectations; congruence between patient preferences and patient care; clinician time use; quality of patient documentation and cost-effectiveness. CONCLUSION: This survey provided crucial information to successfully develop DSS for evidence- and patient preference-based illness management that are perceived helpful by their potential users.

Demography↗
PubMed2004

Norwegian nurses' perceived barriers and facilitators to research use.

A descriptive study was conducted to examine perioperative nurses' perceptions of barriers and facilitators to the use of research findings in nursing practice. The study's findings indicate that the most important barriers are research literature not being compiled in one place, lack of time to read research articles and to implement research findings, uncooperative physicians, insufficient resources, and lack of access to information. The nurses had a positive attitude toward research, but they lacked the competence to assess research findings. Study days, education programs, and research nurses in clinical practice are recommended to remove these obstacles.

Adult↗
PubMed2003

Effects of a computerized system to support shared decision making in symptom management of cancer patients: preliminary results.

OBJECTIVE: (1) To evaluate preliminary effects of a computerized support system on congruence between patients' reported symptoms and preferences and those addressed in the patient consultation and (2) to investigate the system's ease of use, time requirements, and patient satisfaction. DESIGN: Fifty-two patients were randomly assigned to intervention or control conditions. MEASUREMENTS: Cancer patients scheduled for an outpatient visit used the system on a tablet computer to report their symptoms and preferences prior to their consultation. This information was processed, printed, and provided to the patient and clinician in the subsequent consultation in the experimental group but not in the control group. RESULTS: While patients in both groups were equivalent at baseline in symptom characteristics, there was significantly greater congruence between patients' reported symptoms and those addressed by their clinicians in the experimental group. The system scored high on ease of use. There were no significant group differences in patient satisfaction. CONCLUSION: This study provided beginning evidence that eliciting patients' symptoms and preferences and providing clinicians with this information prior to consultation can be an effective and feasible strategy to improve patient-centered care.

Attitude to Computers↗
PubMed2003

Usefulness and effects on costs and staff management of a nursing resource management information system.

While administrative information systems can assist nurse managers to improve cost containment and resource management of their units, such effects cannot be known without rigorous evaluations. This article presents evaluation results of CLASSICA, an information system designed to provide decision support for nurse managers in financial management, resource allocation, and activity planning. CLASSICA demonstrated a 41% reduction in expenditures for overtime and extra hours during the evaluation period as compared with a 1.8% reduction in control units that did not use the system. Nurse managers reported a substantial improvement in management information and stated that they had gained control over costs. The system helped them analyse the relationships between patient activity, staffing and costs of nursing care. Nurse managers also reported high satisfaction with the system, the information and decision support provided, and its ease of use. These results suggest that CLASSICA is a decision support system that can successfully assist nurse managers in effectively managing their units.

Decision Support Systems, Management↗
PubMedDate not supplied

Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration.

The importance of including patient preferences in decisions regarding their care has received increased emphasis over recent years. Medical informatics can play an important role in improving patient-centered care by developing decision support systems to support the inclusion of patient preferences in clinical decision making. However, development of such systems is a complex task that requires the integration of knowledge from four major research areas: (1) the clinical domain, for understanding of the decision problem, (2) decision science and research on shared decision making, to provide the theoretical underpinnings and techniques for eliciting patient preferences; (3) medical informatics, to provide the technology and algorithms for the collection, processing, structure, presentation and integration of patient preferences into patient care; and (4) organizational knowledge, to adapt the decision support system to the practices and work flows of clinicians and the organizational and professional context of the clinical practice settings. This paper describes a conceptual model comprising eight key components that are important to be considered in the development, implementation, and evaluation of decision support systems for shared decision making in patient care. The example of CHOICE, a decision support system to assist nurses in eliciting and integrating rehabilitation patients' preferences for functional performance in patient care is used to illustrate the eight components.

Choice Behavior↗
PubMedDate not supplied

Predictors of women's exercise maintenance after cardiac rehabilitation.

PURPOSE: Less than 50% of persons who participate in cardiac rehabilitation (CR) programs maintain an exercise regimen for as long as 6 months after completion. This study was conducted to identify factors that predict women's exercise following completion of a CR program. METHODS: In this prospective, descriptive study, a convenience sample of 60 women were recruited at completion of a phase II CR program. Exercise was measured using a heart rate wristwatch monitor over 3 months. Predictor variables collected at the time of the subjects' enrollment were age, body mass index, cardiac functional status, comorbidity, muscle or joint pain, motivation, mood state, social support, self-efficacy, perceived benefits or barriers, and prior exercise. RESULTS: Of women, 25% did not exercise at all following completion of a CR program and only 48% of the subjects were exercising at 3 months. Different predictors were found of the various dimensions of exercise maintenance. Predictors of exercise frequency were comorbidity and instrumental social support. Instrumental social support was the only predictor of exercise persistence. Comorbidity was the only predictor of exercise intensity. The only predictor of the total amount of exercise was benefits or barriers. CONCLUSIONS: Interventions aimed at increasing women's exercise should focus on increasing their problem-solving abilities to reduce barriers to exercise and increase social support by family and friends. Because comorbidity was a significant predictor of exercise, women should be encouraged to use exercise techniques that reduce impact on muscles and joints (eg, swimming) or exercising for short periods several times a day.

Adult↗
PubMedDate not supplied

Handheld technology to improve patient care: evaluating a support system for preference-based care planning at the bedside.

OBJECTIVE: Despite an increasing movement toward shared decision making and the incorporation of patients' preferences into health care decision making, little research has been done on the development and evaluation of support systems that help clinicians elicit and integrate patients' preferences into patient care. This study evaluates nurses' use of CHOICE, a handheld-computer-based support system for preference-based care planning, which assists nurses in eliciting patients' preferences for functional performance at the bedside. Specifically, it evaluates the effects of system use on nurses' care priorities, preference achievement, and patients' satisfaction. DESIGN: Three-group sequential design with one intervention and two control groups (N=155). In the intervention group, nurses elicited patients' preferences for functional performance with the handheld-computer-based CHOICE application as part of their regular admission interview; preference information was added to patients' charts and used in subsequent care planning. RESULTS: Nurses' use of CHOICE made nursing care more consistent with patient preferences (F=11.4; P<0.001) and improved patients' preference achievement (F=4.9; P<0.05). Furthermore, higher consistency between patients' preferences and nurses' care priorities was associated with higher preference achievement (r=0.49; P<0.001). CONCLUSION: In this study, the use of a handheld-computer-based support system for preference-based care planning improved patient-centered care and patient outcomes. The technique has potential to be included in clinical practice as part of nurses' routine care planning.

Aged↗