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Biomedical subjects

E C Devine

Publications and source records attributed to E C Devine.

18 recordsLinked to original sources
PubMed2001

A computerized system for tracking practice and prescriptive patterns of family nurse practitioner students.

Decisions about the fit between advanced practice nursing curricula and the real world of primary care practice should be based on data and not on intuition. The purpose of this article is to describe a computerized database system that can be used to: 1) track practice (including prescribing) patterns of nurse practitioner (NP) students; 2) address data issues that commonly arise; and 3) describe NP students' practice during their education to prospective employers. The database system uses both the Family Nurse Practitioners Log (FNPLOG), a faculty-developed software program, and Epi Info, a companion public domain software program. Variables are categorized as being related to sociodemographic, diagnostic, or prescriptive components of primary care. The system provides a simple, efficient, and feasible way of computerizing, analyzing, and evaluating students' clinical experience and practice patterns. The implications for advanced practice nursing education will be illustrated along with other potential uses of the database system.

Data Collection↗
PubMed2000

Nurse practitioner student prescriptive patterns.

As employment of nurse practitioners (NPs) increases in health care systems, there is a need to have current data on their prescribing practices and patterns, and to implement a system for updating such data. This study reports prescriptive data based upon 10,421 primary care visits conducted by 55 family NP students over a 15-month period in 1997 and 1998. Numbers of over-the-counter drugs taken regularly, prescription drugs currently prescribed and prescription drugs prescribed or refilled at the visit were recorded in addition to types of drugs, compliance issues, diagnoses rendered and sociodemographic information. Individual student data were aggregated and analyzed using Epi Info (Epidemiology Program Office of the Centers for Disease Control) and SPSS-PC. Results identified that: 1) the majority of patient visits involved the prescription of 1-2 drugs (88%); 2) major compliance issues included financial concerns, knowledge deficits, and complexity/demands of treatment; 3) commonly rendered diagnoses at drug visits for chronic conditions were hypertension and diabetes; for acute conditions, otitis sinusitis and upper respiratory infections; 4) anti-microbial agents, drugs used for relief of pain, and cardiovascular drugs account for 60% of drug mentions; and 5) the numbers of drugs prescribed or refilled at visits were similar by type of preceptor, except fewer single drugs were prescribed or refilled at visits supervised by nurse preceptors. Findings are discussed relative to deepening the understanding of advanced practice nursing education and the prescribing practices of NP students and their preceptors.

Adolescent↗
PubMed1999

AHCPR clinical practice guideline on surgical pain management: adoption and outcomes.

Pain management practices and short-term patient outcomes in nine acute care hospitals in Milwaukee, Wisconsin, were studied at two points in time. One-and-a-half years after the Agency for Health Care Policy and Research's (AHCPR) Clinical Practice Guideline on Acute Pain Management was published, data from 330 adult surgical patients were collected (Time I). These data were contrasted with data from 373 adult surgical patients collected 2 years later (Time II). There were significant increases in the percentage of patients who reported being taught how to report pain using a pain rating scale and about setting a pain goal preoperatively; in the percentage of patient hospital records with at least one documented numeric pain rating; and in the percentage of patients who received analgesics by intravenous administration. However, pain management practices continued to differ from recommendations in the AHCPR guideline. No significant improvement was noted in the short-term outcomes of patient-rated pain or patient satisfaction with pain management. Availability of well-published guidelines alone may be insufficient to ensure comprehensive adoption of guidelines that are multidimensional in nature and to obtain improvements in patient outcome.

Acute Disease↗
PubMed1996

Meta-analysis of the effects of psychoeducational care in adults with asthma.

Meta-analysis was conducted with 31 studies published between 1972 to 1993 on the effect of psychoeducational care (education, behavioral skill development, cognitive therapy, and/or nonbehavioral support/counseling) in adults with asthma. Fifty-eight percent of studies had subjects that were randomly assigned to treatment condition. Statistically significant beneficial effects were obtained on the occurance of asthmatic attacks (d+ = .56, n = 11), dynamic respiratory volume (d+ = .34, n = 10), peak expiratory flow rate (d+ = .29, n = 6), functional status (d+ = .46, n = 4), adherence to treatment regime (d+ = .78, n = 7), utilization of health care (d+ = .29, n = 10), use of PRN medications (d+ = .62, n = 8), psychological well-being (d+ = .53, n = 6), and psychomotor knowledge of inhaler use (d+ = 1.02, n = 4). Methodological weaknesses were identified that should be rectified in future research. Nonetheless, based on the best evidence available to date, both education and relaxation-based behavioral interventions have been shown to improve important clinical outcomes in adults with asthma.

Activities of Daily Living↗
PubMed1996

Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease.

Meta-analysis, a quantitative research review, was conducted on 65 studies of the effect of education, exercise and/or psychosocial support (hereafter called psychoeducational care) in adults with chronic obstructive pulmonary disease (COPD). Studies ranged in publication date from 1954 to 1994. Only 34% of studies had subjects that were randomly assigned to treatment condition, and only 15% of studies had a placebo-type control group. Analyses by type of treatment showed that pulmonary rehabilitation (large muscle exercise and education plus a variety of psychosocial or behavioral interventions) had statistically significant beneficial effects on psychological well-being (d+ = 0.58, n = 13), endurance (d+ = 0.77, n = 13), functional status (d+ = 0.63, n = 8), VO2 (d+ = 0.56, n = 5), dyspnea (d+ = 0.71, n = 10), and adherence (d+ = 1.76, n = 2). A statistically significant beneficial effect of pulmonary rehabilitation was not found on Forced Expiratory Volume at 1 s. Across 7 outcomes examined, treatments including education-alone had significant beneficial effect on the accuracy of performing inhaler skills (d+ = 1.27, n = 7). Based on a very small sample of studies, a non-significant but small or medium sized effect of education-alone was evident on health care utilization (d+ = 0.26, n = 3) and on adherence to treatment regimen (d+ = 0.50, n = 2). Such results are inconclusive, suggesting that further research may be indicated. Relaxation-alone had statistically significant beneficial effects on both dyspnea (d+ = 0.91, n = 3) and psychological well-being (d+ = 0.39, n = 6). The research base has methodological weaknesses that should be rectified in future research. Nonetheless, based on the best evidence available to date, identified types of psychoeducational care have been shown to improve the functioning and well-being of adults with COPD.

Adult↗
PubMed1995

The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies.

PURPOSE/OBJECTIVES: To determine how educational and psychosocial care provided to adults with cancer affects seven outcomes--anxiety, depression, mood, nausea, vomiting, pain, and knowledge. DESIGN: Meta-analysis. SAMPLE: 116 intervention studies. A standardized mean difference between a treatment and control group (i.e., an effect-size value) was calculated for 98 studies; for 18 additional studies, it was only possible to code the direction of treatment effect (i.e., whether the treatment or control group had a higher score). Most analyses were limited to the 98 studies from which an effect-size value was obtainable. These studies were published between 1976 and 1993 and were based on data obtained from 5,326 patients with cancer. METHODS: A comprehensive literature search yielded more than 20,000 potentially relevant citations that were reviewed. Study, subject, treatment, and outcome characteristics of the studies meeting selection criteria were coded. MAIN RESEARCH VARIABLES: Manner of subject assignment to treatment condition; type of control group; publication form; type of psychoeducational care; and the outcomes of anxiety, depression, mood, nausea, vomiting, pain, and knowledge. FINDINGS: Statistically significant, beneficial effects were found in relation to all seven of the outcomes. Three threats to validity were examined and were not found to be a problem related to the outcomes examined. CONCLUSIONS: Psychoeducational care was found to benefit adults with cancer in relation to anxiety, depression, mood, nausea, vomiting, pain, and knowledge. Differentiating among the effectiveness of various types of psychoeducational care was problematic. To maximize the utility of this knowledge for clinicians, more research is needed to evaluate the relative effectiveness of different types of psychoeducational care. IMPLICATIONS FOR NURSING PRACTICE: A strong research base has established the beneficial effects of psychoeducational care. Clinicians should examine their practice to determine if research-based psychoeducational care is being used sufficiently.

Adult↗
PubMed1992

Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies.

A quantitative review of the literature (meta-analysis) was conducted with 191 studies of the effects of psychoeducational care on the recovery, postsurgical pain and psychological distress of adult surgical patients. Studies issued between 1963 and 1989 were included in the review. Statistically reliable, small to moderate sized beneficial effects were found on recovery, postoperative pain and psychological distress. In further analyses it was shown that these beneficial effects were not an artifact of the biases associated with the decision whether to publish a paper, low internal validity, measurement subjectivity, or a Hawthorne effect. The overall efficacy of psychoeducational care provided to adult surgical patients has been reconfirmed with this larger sample of studies. It is particularly noteworthy that these findings are of more than strictly historical interest. Despite changes in health care delivery, beneficial effects continue even in studies issued between 1985 and 1989. Implications for clinical practice are drawn.

Adult↗
PubMed1991

The Nursing Minimum Data Set: abstraction tool for standardized, comparable, essential data.

The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making.

Education, Nursing↗
PubMed1990

Enhancing surgical nurses' patient education: development and evaluation of an intervention.

This research tested whether staff nurses could provide enhanced patient education and whether increases in education improved surgical patient outcomes. A protocol for patient education was developed from earlier research. Then a multifocal intervention was implemented to motivate and teach staff nurses and to increase structural support for patient education. Following the intervention, patients reported receiving more preoperative information and psychosocial support, but not skills training. These increases occurred without measurable opportunity costs in other areas of nurses' work and generalized to nontargeted patient groups. Concomitantly, patients experienced shortened postoperative hospital stays and decreased use of anti-emetics/sedatives and hypnotics, demonstrating the clinical effectiveness of the increased education.

Education, Nursing, Continuing↗
PubMed1988

Test of the nursing minimum data set: availability of data and reliability.

An initial study of the availability of the elements in the Nursing Minimum Data Set (NMDS) and intercoder reliability across four types of clinical settings is reported. These clinical settings included an acute care hospital, a nursing home, a home health care agency, and two ambulatory care clinics. The health records of 116 randomly selected subjects were reviewed to determine the availability of the NMDS elements. A randomly selected subset of 23 of these records provided data on intercoder agreement. All but four of the NMDS elements were available for 85% or more of the subjects. The average intercoder agreement across all NMDS elements was a satisfactory 91%. However, the intercoder agreement on some NMDS elements was much lower, suggesting a need to refine the definitions and procedures for collecting some of the NMDS elements. Where appropriate, coefficient Kappa and Pearson product moment correlation statistics for reliability are reported on individual NMDS elements.

Demography↗
PubMed1988

Clinical and financial effects of psychoeducational care provided by staff nurses to adult surgical patients in the post-DRG environment.

A three-hour, two-stage workshop for staff nurses on providing patient education and psychosocial support was evaluated in terms of its effects on patient welfare and recovery. Subjects were 148 persons who had either a cholecystectomy, other abdominal surgery, or transurethral resection of the prostate (TURP). Two hundred and six additional control subjects were obtained from a nearby hospital. Both hospitals were owned by the same corporation and had many of the same surgeons. After the workshop, experimental subjects used fewer sedatives or antiemetics, fewer hypnotics, and were discharged from the hospital on the average half a day sooner.

Abdomen↗
PubMed1986

Clinical and cost-saving effects of psychoeducational interventions with surgical patients: a meta-analysis.

Meta-analysis of 102 studies was conducted to examine how psychoeducational interventions influence recovery, pain, psychological well-being, and satisfaction with care among hospitalized adult surgery patients. Statistically reliable and positive effects were found on each of these four classes of outcome. Further analyses showed that the effects could not be attributed to biases associated with the decision to publish, low internal validity, measurement subjectively, or a Hawthorne effect. Analyses of the subset of outcomes with most direct cost implications showed that positive, cost-relevant effects were obtained across a wide range of patients, treatment providers, hospital settings, and historic periods.

Adolescent↗
PubMedDate not supplied

Use of the nursing minimum data set to describe nursing interventions for select nursing diagnoses and related factors in an acute care setting.

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1991. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described.

Acute Disease↗
PubMedDate not supplied

A meta-analytic analysis of effects of psychoeducational interventions on length of postsurgical hospital stay.

Forty-nine studies of the relationships between brief psychoeducational interventions and the length of postsurgical hospitalization are reviewed using meta-analysis. Results show that interventions reduce hospital stay about 1 1/4 days and that reduction does not depend on whether the studies were published or not, whether the discharging physician was aware of the patient's experimental condition, or whether studies were lacking in internal validity. The interventions' effects on length of hospital stay are distinctly smaller in more recent studies, with analysis suggesting current treatments incorporate fewer components than earlier studies. Lesser effects are also found when the treatment is compared with a placebo-treatment group rather than a usual-care control group. This may be because placebo procedures often include educational and socially supportive components that constitute part of the psychoeducational interventions under review. The present study, providing a more stable foundation than previously available, supports the belief that brief psychoeducational interventions may be cost effective with surgical patients of many kinds because the length of hospital stay is reduced.

Cost Control↗
PubMedDate not supplied

A meta-analysis of the effects of psychoeducational care in adults with hypertension.

A meta-analysis of 102 studies was conducted to determine the effects of psychoeducational care on blood pressure (n = 89), knowledge about hypertension (n = 30), medication compliance (n = 23), weight (n = 16), compliance with health care appointments (n = 11), and anxiety (n = 6). Small- to medium-sized statistically significant beneficial effects were found on blood pressure for several types of psychoeducational care (education only, behavioral monitoring only, and relaxation). However, in the better controlled studies, the effect of relaxation on blood pressure was much smaller and not statistically significant. Statistically significant large treatment effects were obtained on knowledge, medication compliance, and compliance with health care appointments. Threats to validity limited conclusions about the effects of psychoeducational care on the weight and anxiety of adults with hypertension.

Adult↗