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Biomedical subjects

J A Effken

Publications and source records attributed to J A Effken.

7 recordsLinked to original sources

Informational basis for expert intuition.

AIM: Intuition has been cited as an integral part of nursing clinical expertise. Responding to the recent scholarly debate over the status of expert nursing intuition as part of the art or science of nursing, this article proposes an alternative view that may provide an informational basis for what has been described phenomenologically as intuition. RATIONALE: Two reasons for the dispute over the status of nursing intuition as 'art' or 'science' are proposed: The first is methodological. The second relates to intuition's close link with perception and underlying assumptions about perception. By examining intuition through an ecological psychology framework, the problem takes on a different character, one that is no longer focused solely on the expert's cognitive (or perceptual) processes, but also on the information provided by the patient and the context of care. CONCLUSIONS: This perspective has several implications for nursing. By investigating information sources (i.e. higher order variables or constraints) in the nurse-patient encounter, the problem of intuition may be clarified, and perhaps simplified. We may find that what nurse researchers have called 'intuition' is what Gibson (1966, 1986) termed 'direct perception.' Intuition as direct perception is information-based and lawful. Finally, although some aspects of intuition may be hard-wired through evolution, intuition as direct perception can be developed through education and extensive, deliberate practice with appropriate exemplars. Characterized as direct perception, intuition is an observable, lawful phenomenon that is measurable, potentially teachable, and appropriately part of nursing science.

Art↗

Making the constraints visible: testing the ecological approach to interface design.

A haemodynamic monitoring and control task was used to evaluate the ecological approach to interface design for complex high-technology environments. Guidelines proposed by Bennett and Flach (1992) were used to design multilevel displays that made visible (a) anatomical constraints, and (b) causal constraints on haemodynamic systems. These displays were compared with a traditional display that showed pressure and flow values in five separate graphs. Simulations of clinical problems were generated by a computer model and presented in an interactive computer environment. Critical care nurses and nursing students observed changes in pressures and flow corresponding to certain disease states and corrected those states using simulated drugs. For both groups, speed and accuracy were progressively improved by the enhanced, multilevel displays.

Computer Simulation↗

Making the relationships visible: testing alternative display design strategies for teaching principles of hemodynamic monitoring and treatment.

A hemodynamic monitoring and control task was used to explore the utility of perceptually based displays to teach basic hemodynamic principles. The baseline display showed discrete values of key hemodynamic data elements. Alternative displays showed (a) anatomical relationships between those elements, and (b) causal constraints. Critical care nurses and student nurses used simulated "drugs" to correct simple hemodynamic disturbances using the three displays. Showing the anatomic constraints on pressure and flow improved treatment coordination by novices. Showing how etiological factors related to symptoms shortened the time required to reach a criterion level of performance and improved treatment coordination for both novices and experts.

Computer Graphics↗

Impact of organizational redesign.

Little in-depth objective information is available about the outcomes of restructuring or reengineering. One reason for this is the difficulty of conducting traditional research within the context of dynamic organizational development activities. The authors describe an alternative program evaluation approach that proved successful for assessing and enhancing large-scale organizational change in an acute-care medical center. Sample results are presented and recommendations made for increasing an evaluation's usefulness by tailoring reports to the user.

Hospital Restructuring↗

Design and implementation of an outcomes management model.

In today's capitation-based reimbursement environment, acute care staff nurses must coordinate patient care considering the full continuum of care. To do so effectively, staff nurses need tools to accurately predict patient needs, adjust service intensity accordingly, and evaluate the outcomes of the care provided. The design and implementation of a model to support acute care staff nurses in that effort is described. The model's implementation was evaluated, in part, using a ten-item pre- and post-implementation survey. The survey showed that staff nurses who participated in the final educational offering on the model increased significantly their reported use of aggregate data for planning care. To achieve the greatest impact, the model needs to evolve so that it is applied earlier in the care process than at initial hospitalization. Ideally, this should occur during a wellness visit or enrollment in a health plan.

Acute Disease↗

Interface design and cognitive style in learning an instructional computer simulation.

An experimental design was used to investigate how cognitive style interacts with interface design to affect users' abilities to learn to use a computer simulation. Eighteen nursing students were assigned to two groups, based on their cognitive style, and asked to solve 3 physiologic problems using 3 interface designs: a strip-chart display, an integrated balloon display, and an etiologic display. Students were given up to 2 minutes to solve each problem by administering 6 different hypothetical drugs targeted at different aspects of the simulated hemodynamic system. A mixed-design analysis of variance was used to determine the effects of interface design and cognitive style on number of problems solved, time to initiate treatment, percentage of time system maintained within normal parameters, and number of drugs used. We found that the effects of cognitive style on performance were mediated by interface design and tended to decrease with practice.

Analysis of Variance↗