Biomedical subjects

Frank D Hicks

Publications and source records attributed to Frank D Hicks.

10 recordsLinked to original sources

PubMed2005

The phenomenology of deciding about hemodialysis among Taiwanese.

The purpose of this study was to describe the experience of making hemodialysis choices among Taiwanese with end-stage renal disease (ESRD). Using Colaizzi's phenomenological method, 12 ESRD patients provided in-depth, audiotaped interviews that were then transcribed and analyzed. The results of the data analysis revealed three broad categories and ten themes. The first category, confronting the dialysis treatment, included four themes: fear caused by false beliefs, a sense of threat to life, concern about the impairment of self-concept, and fear of physical limitations. The second category, seeking further information, included three themes: getting opinions of family members, seeking professional confirmation, and exploring alternative treatments. The third category, living with dialysis, included three themes: worsening symptoms, support of the family, and law of causation. These categories and themes revealed the difficulties that ESRD patients dealt with and the influence these difficulties and their culture had on the treatment choice.

Adaptation, Psychological↗

PubMed2005

An ontological view of advanced practice nursing.

Identifying, developing, and incorporating nursing's unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may not necessarily reflect those of nursing. A lack of focus may lead current advanced practice nursing curricula and emerging doctorate of nursing practice programs to mirror the logical positivist paradigm and perspective of medicine. This article presents an ontological perspective for advanced practice nursing education, practice, and research.

Education, Nursing, Graduate↗

PubMed2004

Psychometric testing of the self-care of heart failure index.

BACKGROUND: Self-care is believed to improve outcomes in heart failure (HF) patients. However, research testing this assumption is hampered by difficulties in measuring self-care. The purpose of this study was to evaluate the psychometric properties of a revised instrument measuring self-care in persons with HF, the Self-Care of Heart Failure Index (SCHFI). The SCHFI is a self-report measure comprised of 15 items rated on a 4-point response scale and divided into 3 subscales. METHODS AND RESULTS: Psychometric testing was done using data from 760 HF patients (age 70.36 +/- 12.3 years, 51% male) from 7 sites in the United States. Reliability of the SCHFI (alpha.76) was adequate. Reliability of the Self-Care Maintenance subscale was lower than desired (alpha.56) but the reliability of the other subscales was adequate: Self-Care Management (alpha.70) and Self-Care Self-Confidence (alpha.82). Construct validity was supported with satisfactory model fit on confirmatory factor analysis (NFI=.69, CFI.73). Construct validity was supported further with significant total and subscale (all P <.05) differences between patients experienced with HF and those newly diagnosed, consistent with the underlying theory. CONCLUSION: Low reliability of the Self-Care Maintenance subscale was expected because the items reflect behaviors known to vary in individuals. The reliability and validity of the SCHFI are sufficient to support its use in clinical research.

Aged↗

PubMed2003

Self-management decision influences in heart failure: a preliminary investigation.

Self-management decision making places significant cognitive demands on individuals with heart failure (HF). Before theoretically valid decision supports can be developed, a better understanding of underlying decision characteristics is needed. The purpose of this preliminary study was to describe sources of self-management decision influences for individuals (N = 38) with varying levels of HF (New York Heart Association (NYHA) classifications). Therapeutic value was the most influential source of self-management decision making for these patients, followed by personal beliefs and values, information sources, symptom influence, and task difficulty across all NYHA classes. Symptom influence was least influential for persons in Class II, whereas task difficulty was least influential for those in Classes III and IV. Moderate and significant associations were noted between information sources and personal beliefs and values and between information sources and symptom influence. As the disease progressed, a trend toward fewer decision influences, especially in the task difficulty scale, was noted.

Decision Making↗

PubMed2003

Frequency and outcomes of transient myocardial ischemia in critically ill adults admitted for noncardiac conditions.

BACKGROUND: Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia. OBJECTIVES: To detect myocardial ischemia and injury in patients admitted for noncardiac conditions and to examine the relationship of myocardial ischemia, injury, and acuity to cardiac events. METHODS: Transient myocardial ischemia, acuity, elevations in serum troponin I, and in-hospital cardiac events were examined in 76 consecutive patients. Transient myocardial ischemia, determined by using continuous electrocardiography, was defined as a 1-mm (0.1-mV) change in ST level from baseline to event in 1 or more leads lasting 1 or more minutes. Acuity was determined by scores on Acute Physiology and Chronic Health Evaluation II. RESULTS: A total of 37 ischemic events were detected in 8 patients (10.5%); 32 (86%) were ST-segment depressions, and 35 (96%) were silent. Twelve patients (15.8%) had elevated levels of troponin I. Transient myocardial ischemia, elevated troponin I levels, and advanced age were significant predictors of cardiac complications (R2 = 0.387, F = 15.2, P < .001). Acuity correlated only modestly with increased length of stay in the intensive care unit (r = 0.26, P = .02) and elevated troponin I levels (r = 0.25, P = .03). Patients with transient myocardial ischemia had significantly higher rates of elevations in troponin I (P < .001) and cardiac events (P < .001) than did patients without. CONCLUSIONS: Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.

APACHE↗

PubMed2002

A study of clinical decision making by certified registered nurse anesthetists.

Anesthesia outcomes and related risk factors have been studied for more than 100 years. Varying sample sizes and research methods have been used, with research findings that were open to multiple interpretations. Research with closed malpractice claims demonstrates that American Society of Anesthesiologists physical status II patients undergoing elective procedures are most likely to experience damaging events intraoperatively with resultant postoperative adverse outcomes. The process of care, including clinical decision making, contributes to adverse outcomes. Clinical decision making can be difficult to assess and measure. In this study, the cognitive psychology framework of information-processing theory and literature pertaining to the use of heuristics, or rules of thumb, and clinical biases, were used to analyze cases from the AANA Foundation closed malpractice claims database. This database contains more than 300 files involving St Paul Fire and Marine Insurance Company-covered CRNAs from across the United States. These files were analyzed by 10 CRNA investigators on the AANA Closed Claims research team. Variables such as inadequate preinduction activities, e.g., incomplete preanesthetic assessments, and use of cognitive biases and inaccurate probability estimation were associated with adverse outcomes in this research sample. Teaching of decision science in basic and continuing nurse anesthesia education is advocated.

Anesthetics↗

PubMedDate not supplied

Critical thinking and clinical decision making in critical care nursing: a pilot study.

OBJECTIVE: This pilot study examined the relationship of education level, years of critical care nursing experience, and critical thinking (CT) ability (skills and dispositions) to consistency in clinical decision making among critical care nurses. Consistency was defined as the degree to which intuitive and analytical decision processes resulted in similar selection of interventions in tasks of low and high complexity. DESIGN: The study was nonexperimental and correlational. SAMPLE: Critical care nurses (n = 54) from adult critical care units in 3 private teaching hospitals. The majority of nurses held a BSN or MSN and had an average of 9 years of direct clinical experience in the care of the critically ill. RESULTS: Decision-making consistency decreased significantly between low-complexity and high-complexity tasks. Both intuitive and analytical decision processes produced clear intervention selections in the low-complexity task, although the analytical process resulted in a more complete specification of interventions. In the high-complexity task, however, only the intuitive process resulted in a clear, plausible, and safe specification of interventions. Education and experience were not related to CT ability, nor was CT ability related to decision-making consistency. Only greater years of critical care nursing experience increased the likelihood of decision-making consistency. CONCLUSIONS: Overall, intuitive decision processes resulted in more clinically consistent selection of interventions across tasks. More investigation is needed to examine the influence of decision heuristics, and the conceptualization and measurement of CT abilities among practicing nurses.

Adult↗

PubMedDate not supplied

The unrecognized paradigm shift in nursing: implications, problems, and possibilities.

An important paradigm (or worldview) shift is occurring in science that affects the nature of nursing education, practice, and research. The shift from positivism to postmodernism and now to neomodernism has received little attention in US nursing and as such may forestall many opportunities related to such change. The nature of this paradigm shift and its effects on selected aspects of nursing education, practice, and research are described, and related implications, problems, and possibilities are explored. Neomodernism is discussed as one future for nursing that encompasses aspects of both positivism and postmodernism but yet goes beyond these to include important metanarratives as traditional values and beliefs of nursing. The work of Laudan and Lakatos are explored as supportive of this neomodernist approach.

Education, Nursing↗

PubMedDate not supplied

Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study.

Oncologic outcomes of gastroesophageal surgery may be similar, but little is known about the impact on patients' postoperative symptom experience and quality of life (QOL). The purpose of this pilot study was to describe overall QOL and symptom experience of individuals who underwent either total gastrectomy with Roux-en-Y esophagojejunostomy or esophagogastrectomy for adenocarcinoma of the gastroesophageal junction. The Gastroenterology Quality of Life Index (GQLI) and the Life After Gastric Surgery (LAGS), developed by the investigators for measuring symptom frequency, were used to measure variables of interest. The sample (n = 27) had a relatively high QOL, but experienced difficulties with eating patterns, physical functioning, socialization, and happiness. There were significant differences between the two procedures related to QOL and symptom frequency in that individuals who had the total gastrectomy fared somewhat better. Further, patients who had esophagogastrectomy had greater symptom frequency and significantly poorer QOL. Although initially compelling, these data warrant further investigation into the QOL and symptom impact in a more diverse population of patients with cancer of the stomach or esophagus. These results, however, suggest several areas where nursing interventions could help these patients.

Adenocarcinoma↗

PubMedDate not supplied

The life after gastric surgery index: conceptual basis and initial psychometric assessment.

Understanding the influence of symptoms on an individual's life is important when providing nursing care. Currently, however, there are few clinically useful tools for assessing symptoms in individuals who have had surgery for gastric cancer. The Life After Gastric Surgery Index was developed to address this need by providing a multidimensional measure of symptom experience (frequency, severity, and bothersomeness) of 18 common symptoms patients may experience after gastroesophageal surgery for cancer. Initial psychometric assessment of the Life After Gastric Surgery Index has demonstrated acceptable internal consistency reliability and strong face, content, and criterion-related validity on two small samples. This paper reviews the conceptual basis of the Life After Gastric Surgery Index, the results of its initial psychometric assessments, and the implications this measure has for clinical practice and research.

Humans↗