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Biomedical subjects

L J Davidson

Publications and source records attributed to L J Davidson.

At least 19 recordsLinked to original sources
PubMed2001

Validity evidence for using a general critical thinking test to measure nursing students' critical thinking.

This study examined validity evidence for using a general test of critical-thinking skills and dispositions to measure nursing students' critical-thinking abilities. Content evidence indicated strong support for the theoretical framework underlying the test but less support for the way in which the critical-thinking constructs were specifically measured. Scores related to critical-thinking skills demonstrated significant but low correlations with grade point averages, were moderately correlated with SAT scores, and were uncorrelated with scores related to critical-thinking dispositions. The evidence suggests that nursing programs may need to reconsider how critical thinking should be measured and evaluated.

Adult↗
PubMed2001

Developing a multi-institutional nursing report card.

As regulatory and public interest groups demand information on the quality of patient care outcomes produced by their hospitals and care providers, nurse administrators are establishing processes for the effective and efficient definition, retrieval, and reporting of patient outcomes thought to be nursing-sensitive. The authors describe the administrative infrastructure and the data management processes used by one large integrated healthcare system to establish a nursing report card and maintain it for several years.

Benchmarking↗
PubMed2001

Benchmarking patient outcomes.

PURPOSE: To examine the usefulness of three types of benchmarking for interpreting patient outcome data. DESIGN: This study was part of a multiyear, multihospital longitudinal survey of 10 patient outcomes. The patient outcome used for this methodologic presentation was central line infections (CLI). The sample included eight hospitals in an integrated healthcare system, with a range in size from 144 to 861 beds. The unit of analysis for CLI was the number of line days, with the CLI rate defined as the number of infections per 1,000 patient-line days per month. METHODS: Data on each outcome were collected at the unit level according to standardized protocols. Results were submitted via standardized electronic forms to a central data management center. Data for this presentation were analyzed using a Bayesian hierarchical Poisson model. Results are presented for each hospital and the system as a whole. FINDINGS: In comparison to published benchmarks, hospital performances were mixed with regard to CLI. Five of the 8 hospitals exceeded 2.2 infections per 1,000 patient-line days. When benchmarks were established for each hospital using 95% credible intervals, hospitals did reasonably well with only isolated months reaching or going beyond the benchmark limits. When the entire system was used to establish benchmarks with the 95% credible intervals, the hospitals that reached or exceeded the benchmark limits remained the same, but some hospitals had CLI rates more frequently in the upper 50% of the benchmarking limits. CONCLUSIONS: Benchmarking of quality indicators can be accomplished in a variety of ways as a means to quantify patient care and identify areas needing attention and improvement. Hospital-specific and system-wide benchmarks provide relevant feedback for improving performance at individual hospitals.

Benchmarking↗
PubMed1998

Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison.

BACKGROUND: Little information is available on the practice of acute care nurse practitioners and physician assistants in acute care settings. OBJECTIVES: To compare the care activities performed by acute care nurse practitioners and physician assistants and the outcomes of their patients with the care activities and patients' outcomes of resident physicians. METHODS: Sixteen acute care nurse practitioners and physician assistants and a matched group of resident physicians were studied during a 14-month period. Data on the subjects' daily activities and on patients' outcomes were collected 4 times. RESULTS: Compared with the acute care nurse practitioners and physician assistants, residents cared for patients who were older and sicker, cared for more patients, worked more hours, took a more active role in patient rounds, and spent more time in lectures and conferences. The nurse practitioners and physician assistants were more likely than the residents to discuss patients with bedside nurses and to interact with patients' families. They also spent more time in research and administrative activities. Few of the acute care nurse practitioners and physician assistants performed invasive procedures on a regular basis. Outcomes were assessed for 187 patients treated by the acute care nurse practitioners and physician assistants and for 202 patients treated by the resident physicians. Outcomes did not differ markedly for patients treated by either group. The acute care nurse practitioners and physician assistants were more likely than the residents to include patients' social history in the admission notes. CONCLUSIONS: The tasks and activities performed by acute care nurse practitioners and physician assistants are similar to those performed by resident physicians. However, residents treat patients who are sicker and older than those treated by acute care nurse practitioners and physician assistants. Patients' outcomes are similar for both groups of subjects.

Acute Disease↗
PubMed1993

Sputum quality: can you tell by looking?

BACKGROUND: Nurses are responsible for the collection of sputum samples for culture in most institutions, yet they receive little formal training on what a good specimen looks like. METHODS: Three hundred thirty-three consecutively collected expectorated sputum samples and tracheal aspirates were examined to determine the relationship of macroscopic specimen appearance (watery, mucoid, mucopurulent) to specimen quality (good, fair, poor). RESULTS: Of the expectorated sputum samples, 21% were watery, 65% were mucoid, and 14% were mucopurulent. Sixty-five percent of the expectorated sputum samples were good or fair, regardless of appearance. Eighty-seven percent of mucopurulent expectorated sputum samples were good or fair. In the remaining nonmucopurulent specimens, however, there were no predictable markers of specimen quality. CONCLUSIONS: The only specimens that were predictably good were those that were mucopurulent yellow, yellow, or tracheal aspirates.

Humans↗
PubMed1993

Methicillin-resistant Staphylococcus aureus: long-term routes of acquisition in hospital patients.

Five hundred fifty three patients and two personnel (1986-1991) were categorized according to acquisition route of methicillin-resistant Staphylococcus aureus (MRSA) and initial culture date. Of the 555, there were 218 with nosocomial infections, 100 with nosocomial colonizations, 92 with community-acquired infections, and 145 with community-acquired colonizations. Nosocomial infections occurred significantly more often than nosocomial colonizations, community-acquired infections, or colonizations (p < 0.001). Results of this study show that over a long period, our patients acquired MRSA by different routes, none of which were related to seasons of the year. Although seasonal outbreaks of epidemic MRSA are important, an awareness of the occurrence of endemic MRSA is also important because it serves as a reminder that MRSA reservoirs are continuously present in some institutions.

Cross Infection↗
PubMed1991

Flow characteristics of enteral feeding with psyllium hydrophilic mucilloid added.

One therapy for managing diarrhea in patients in intensive care units who are receiving enteral nutrition is administration of psyllium hydrophilic mucilloid (PHM). This laboratory study was conducted to determine whether the addition of PHM (Metamucil) to enteral feeding formula (Entrition) adversely affected the flow characteristics of the feeding formula through a small-bore feeding tube. Descriptive data were obtained from 72 trials of feeding formula with varied infusion rates, formula osmolality and temperature, and PHM concentrations. Two thirds (n = 48) of the trials were successful (PHM did not clog the tubing and obstruct flow). The remaining one third of the trials (n = 24) were unsuccessful. Successful formula infusion was influenced by formula temperature and osmolality but not by infusion rate, PHM concentration, or flow interruption. If formula with PHM was followed by formula without PHM, the infusion was successful regardless of infusion rate or formula osmolality. Thus, the data from this laboratory study indicate that when therapeutic doses of PHM are prescribed, it is feasible for PHM to be mixed in room-temperature feeding formula and infused without clogging the feeding tube.

Administration, Oral↗
PubMed1990

Contamination of enteral feedings and diarrhea in patients in intensive care units.

To investigate the effect of contamination of enteral feeding solutions on the incidence of diarrhea in critically ill patients, 36 adult intensive and coronary care unit patients received enteral feeding by an aseptic or a routine protocol. Cultures of formula were obtained on the first 4 days of enteral feeding. A significantly greater incidence of contamination was found for the routine protocol group than for the aseptic protocol group (p less than 0.05); however, differences in incidence of diarrhea between subjects who did and did not receive contaminated formula were not significant. Subjects who had diarrhea also had significantly lower (p less than 0.05) serum albumin and transferrin levels. The effects of severity of illness, osmolality, and rate of formula administration on incidence of diarrhea were investigated, and these were not found to be significant factors. Implications for nursing practice and further research are generated.

Adult↗
PubMed1989

Pulmonary complications in the patient with acute head injury: neurogenic pulmonary edema.

Neurogenic pulmonary edema (NPE) is a serious complication associated with various central nervous system insults. Experimental and clinical data support the occurrence of pulmonary edema as a result of neurogenic factors. Patients with NPE have increased intracranial pressure and respiratory distress, and their care presents a challenge to critical care nurses. The pathophysiology of this disease is not well understood. We discuss the current theories of NPE, its signs and symptoms, and the nursing management for patients with NPE.

Acute Disease↗
PubMedDate not supplied

The effects of psyllium hydrophilic mucilloid on diarrhea in enterally fed patients.

OBJECTIVE: To investigate the efficacy of psyllium hydrophilic mucilloid (PHM) for prevention of diarrhea and to compare methods of PHM delivery. DESIGN: Experimental. SETTING: University-affiliated Department of Veterans Affairs Medical Center. SUBJECTS: Sixty patients from medical-surgical and intensive care units who received newly initiated enteral feeding via feeding tube. OUTCOME MEASURES: Diarrhea, stool frequency and consistency, and feeding tube obstruction. INTERVENTION: Receipt of PHM (7 gm, twice-daily) added to continuous feeding or given as a bolus with intermittent feeding, or receipt of No PHM for 7 days after initiation of enteral feeding. RESULTS: Fifteen subjects (25%) developed diarrhea (defined as 3 or more liquid stools per day, or 2 or more liquid stools on successive days). There were no significant differences in incidence of diarrhea or percentage of days of diarrhea between subjects who did and did not receive PHM. However, subjects who received PHM in their continuous feedings had a significantly higher number of gelatinous stools, and the combined PHM groups had a significantly lower number of liquid stools and a higher number of normal stools than did subjects who did not receive PHM. For the combined PHM groups, there was a 12% incidence of small-bore feeding tube occlusion--requiring replacement. CONCLUSIONS: Further study with a larger sample is necessary to evaluate trends found in this pilot study and to determine PHM efficacy for prevention of diarrhea. PHM administration may result in small-bore feeding tube obstruction, and thus requires adequate dilution and close monitoring.

Adult↗
PubMedDate not supplied

Staffing and pattern of mechanical restraint use across a multiple hospital system.

BACKGROUND: In an effort to enhance patient safety in acute care settings, governmental and regulatory agencies have established initiatives aimed at limiting the use of mechanical restraints. Concurrently, hospital staffing levels are undergoing changes raising concerns about the impact these changes may have on restraint use. No studies to date have described the impact these two initiatives have had on restraint use in acute care hospitals. OBJECTIVES: To determine across a multiple hospital system: (a) the rates, frequencies, duration, and timing of restraint use, and (b) the relationship between restraint use and staffing. METHODS: This was a secondary analysis of prospective, observational data from a large outcomes database for 10 acute care hospitals. Monthly data were obtained from 94 patient care units for periods ranging from 1-12 months for a total of 566 cumulative months during 1999. RESULTS: The system restraint application duration rate (total restraint hours/total possible hours) was 2.8% (hospital ranges: 0.3-4.4%). More restraints were applied on night shifts (48.8%; n = 5,296) than on day (33.5%; n = 3,634) or evening shifts (17.7%; n = 1,926) (p < .0001) and most applied at midnight (31.7%; n = 3,441) followed by 0600-0900 (33.3%; n = 3,614). There was a weak positive relationship between staffing and restraint use (r = 0.276, p = .0001) at the system level and units with higher staffing levels also had higher baseline restraint use (p < .0001). CONCLUSIONS: Restraint frequency, duration, and timing may have been altered by recent initiatives, and there is beginning evidence that differences exist between community, rural, and tertiary hospitals. While there is a weak positive relationship between higher staffing and restraint use at the system and unit level, further exploration of the influence of other factors, specifically patient acuity, are in order. The finding of unit variability and consistent restraint application times provides a starting point for further quality initiatives or research interventions aimed at restraint reduction.

Humans↗
PubMedDate not supplied

Microorganisms and diarrhea in enterally fed intensive care unit patients.

Thirty-six intensive care unit patients, receiving aseptic or manually (routine) reconstituted enteral feeding formulas, were evaluated prospectively for the relationship of microbial involvement, gastric pH, and antimicrobial therapy to diarrhea. The routine protocol group had a significantly higher incidence of bacterial contamination than the aseptic protocol group (Fisher's exact test, p less than 0.05). There were no significant direct associations between isolate category (Gram-negative bacilli, Gram-positive cocci, Gram-negative cocci, yeast), gastric pH, or antimicrobials and diarrhea. However, two organisms (Group D Enterococci and yeast) were indirectly implicated in some cases of diarrhea.

Adult↗