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Biomedical subjects

Margaret B Harrison

Publications and source records attributed to Margaret B Harrison.

At least 19 recordsLinked to original sources
PubMed2006

Lost in knowledge translation: time for a map?

There is confusion and misunderstanding about the concepts of knowledge translation, knowledge transfer, knowledge exchange, research utilization, implementation, diffusion, and dissemination. We review the terms and definitions used to describe the concept of moving knowledge into action. We also offer a conceptual framework for thinking about the process and integrate the roles of knowledge creation and knowledge application. The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about planned-action theories to be better able to understand and influence change in practice settings.

Education, Continuing↗
PubMed2006

Relationship between nursing interventions and outcome achievement in acute care settings.

The extent to which nursing interventions provided during hospitalization are associated with patients' therapeutic self-care and functional health outcomes was explored with a voluntary sample of 574 patients. Nurses collected data on patient outcomes at admission and discharge using the minimum data set (MDS) and the therapeutic self-care scale (TSCS). Research assistants audited charts for documentation of nursing interventions. The results indicated that nursing interventions aimed at exercise promotion, positioning, and self-care assistance predicted functional status outcome. Higher functional status outcome predicted therapeutic self-care ability at hospital discharge. The results demonstrate that nurses can use MDS and TSCS data on patient outcomes to gain insight into the effectiveness of their interventions.

Activities of Daily Living↗
PubMed2006

The symptom of pain with heart failure: a systematic review.

BACKGROUND: Pain is one of the most compelling reasons for seeking medical attention. Despite frequent hospitalizations and assessments, the symptom of pain is not often associated with heart failure (HF). The role of pain in exacerbations and hospitalization may be important. A systematic review to synthesize research related to reported pain in patients with HF was undertaken and factors considered to be related to the symptom of pain in this population were identified. METHODS AND RESULTS: Relevant articles were identified using MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Included studies focused on patients with HF and reporting on pain. Nine descriptive studies were identified. Five studies focused specifically on patients with HF. The remaining studies examined a population of seriously ill patients including those with HF as an itemized subset. From 23% to 75% of patients with HF reported pain. Factors identified as related to pain include: anxiety, depression, quality of life rated as poor, dyspnea, and more dependencies in activities of daily living. CONCLUSION: People with HF report having pain but as a complex health group, the symptom of pain is not well understood. Pain could be a contributing factor in the breakdown of self-management and the cycle of exacerbations and hospitalization.

Heart Failure↗
PubMed2005

Leg-ulcer care in the community, before and after implementation of an evidence-based service.

BACKGROUND: Leg ulcers usually occur in older patients, a growing population for which increasing health care resources are required. Treatment is mainly provided in patients' homes; however, patients often receive poorly integrated services in multiple settings. We report the results of a prospective study of a community-based care strategy for leg ulcers. METHODS: International practice recommendations and guidelines were adapted to make a new clinical protocol. The new model, for a dedicated service staffed by specially trained registered nurses, established initial and ongoing assessment time frames and provided enhanced linkages to medical specialists. Data were collected for 1 year before and after implementation; outcome measures included 3-month healing rates, quality of life and resource usage. RESULTS: Three-month healing rates more than doubled between the year before implementation (23% [18/78]) and the year afterward (56% [100/180]). The number of nursing visits per case declined, from a median of 37 to 25 (p = 0.041); the median supply cost per case was reduced from 1923 dollars to 406 dollars (p = 0.005). INTERPRETATION: Reorganization of care for people with leg ulcers was associated with improved healing and a more efficient use of nursing visits.

Delivery of Health Care, Integrated↗
PubMed2004

Supportive care needs of parents of children with cancer: transition from diagnosis to treatment.

PURPOSE/OBJECTIVES: To analyze research related to the pediatric oncology population supportive care needs from diagnosis to treatment. DATA SOURCES: Articles published from 1992-2002. DATA SYNTHESIS: 49 studies were included. All six categories of the Supportive Care Needs Framework were found, with most studies addressing one to three of the need categories. Informational (88%) and emotional (84%) needs were identified most frequently. CONCLUSIONS: No one study examined the entire range and types of supportive care needs from diagnosis to treatment. This knowledge is key to planning appropriate care and services. Future research should be directed at understanding the full constellation of needs encountered by parents during this time. Further refinement of the Supportive Care Needs Framework is required to fully define the categories of need. IMPLICATIONS FOR NURSING: Although more research is required, supportive care that focuses on informational and emotional support appears to be most important from diagnosis to treatment. Using a conceptual framework such as the Supportive Care Needs Framework provides a methodology for planning care based on needs.

Adolescent↗
PubMed2004

Factors associated with pressure ulcers in adults in acute care hospitals.

OBJECTIVES: To identify and describe the relationship of factors associated with pressure ulcers in adults in acute care hospitals. DESIGN: Cross-sectional prevalence studies. SETTING: University teaching hospital. PATIENTS: Prevalence studies conducted from 1993 to 1995 with a total of 1992 subjects served as the derivation sample and a 1996 prevalence study with 581 subjects served as the validation sample. MAIN OUTCOME MEASURES: Pressure ulcers and the Braden risk assessment subscale scores. DATA ANALYSIS: Logistic regression analysis was used to derive a model that fit the data and performed well at identifying factors associated with pressure ulcers. Performance of the model, in terms of calibration, was statistically evaluated using the Hosmer-Lemeshow goodness-of-fit test. The effectiveness of the model, in terms of discrimination, was assessed by considering the cut-off values using 2 by 2 classification tables to measure the overall percentage of subjects correctly classified in the validation sample. MAIN RESULTS: Factors associated with pressure ulcers in adults in acute care hospitals were identified as age, male gender, sensory perception, moisture, mobility, nutrition, and friction/shear. Three interactions were also found to be associated with pressure ulcers; 2 interactions (age and sensory perception and moisture and sensory perception) were negatively associated and 1 interaction (nutrition and gender/male) was positively associated with pressure ulcers. The Hosmer-Lemeshow goodness-of-fit test for the derivation sample (.76) and the validation sample (.79) indicated that the model was well calibrated and a good fit. The overall percentage of subjects correctly classified using the validation sample was 88%, indicating that the model performed well. CONCLUSIONS: : This study enhances the knowledge of the relationship of factors associated with pressure ulcers in adults in acute care populations and enhances the use and relative importance of particular Braden Scale sub-scales.

Acute Disease↗
PubMed2004

Understanding venous leg ulcer pain: results of a longitudinal study.

Venous leg ulcer pain experienced during compression bandaging is poorly understood. A prospective, pilot cohort study was initiated to determine the feasibility of conducting a large-scale, repeated measures cohort study of venous leg ulcer pain and to document and describe the venous leg ulcer pain experience during the first 5 weeks of treatment with compression bandages. Eligible individuals admitted to a nurse-led community leg ulcer service in one Canadian community were recruited for the 5-week study. Pain assessment tools (ie, numerical rating scale and short form McGill Pain Questionnaire) were evaluated by 20 venous ulcer patients (mean age = 73.7 years) and their nurses for ease of use during one baseline and five weekly follow-up visits. Health-related quality of life (HRQL) information was obtained. Nurses reported on ease of integrating pain data collection into regular clinical care. Each pain assessment tool was audited for completion. Most participants found the pain assessment tools easy to use, but nurses reported lengthened visit times with some participants as a result of tool administration difficulties, particularly the visual analogue scale (VAS). Overall completeness of pain assessment tools ranged from 85.0% (visual analogue scale) to 96.3% (present pain intensity and word descriptor list). The vast majority of patients (18) reported ulcer pain at baseline. Total mean scores for all pain assessment tools used decreased over time, but most patients reported pain throughout the study. The most common pain descriptors used were "aching," "stabbing," "sharp," "tender," and "tiring." Health-related quality of life was low and did not change during the 5-week study. The results of this study suggest that the vast majority of venous ulcer patients experience pain and that it is feasible to examine this pain in individuals receiving care in the community over time.

Activities of Daily Living↗
PubMed2003

Venous leg ulcer care: how evidence-based is nursing practice?

OBJECTIVES: The objectives of this study were to (1) determine how congruent community-provided leg ulcer care was with best practice for venous leg ulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous leg ulcers. DESIGN: The practice variation study group was an audit of nursing agency client records to determine the provision of care. SETTING AND SUBJECTS: The study population was a home care cohort of persons with venous leg ulcers (n = 66) who received care from one Ontario home care nursing agency between March 1999 and November 1999. INSTRUMENT: The audit tool was developed with a checklist reflecting the common recommendations from 3 international practice guidelines, as well as organizational and clinical factors that may influence or reflect best practice. RESULTS: Half of client records (35/66) included an identified etiology of the leg ulcer. An Ankle Brachial Pressure Index score was documented prior to the initiation of compression on fewer than half of the records (21/44). Regular ulcer measurement was done for 11% of the clients (7/64). Two thirds of the clients (44/66) were treated with compression. More than 60% of the clients (40/66) had been seen by either a dermatologist or a vascular surgeon. Topical antibiotics were prescribed for two thirds of clients (44/64). Fifteen percent of clients (10/66) were assessed for pain, and 17% (11/66) received some form of pain management. Documentation of client education specific to the leg ulcer was present on 3% of records (2/66). The mean number of different nurses providing leg ulcer care to each client was 19. A registered practical nurse was the classification of nurse assigned to 43.8% (29/66) of the clients. CONCLUSION: Several gaps were identified in the care provided. A standardized approach to care is needed that includes a comprehensive leg ulcer assessment to determine the ulcer etiology, determination of an Ankle Brachial Pressure Index score to screen for the presence of arterial disease, and compression for all clients who meet the criteria for venous disease. A reorganization of services is required, which includes an increased role for community nurses in leg ulcer assessment and management. Organizational and clinical factors influencing the delivery of best practice need to be identified and addressed.

Clinical Competence↗
PubMed2003

Prevalence of lower-limb ulceration: a systematic review of prevalence studies.

OBJECTIVE: To determine the prevalence of leg ulcers reported in the literature. DESIGN: A systematic review of prevalence studies of lower-limb ulceration in the adult population was conducted. Critical appraisal of the research papers was guided by published standards for methodologic review of prevalence studies, which were modified to address the issues related to leg ulcers. MAIN RESULTS: Twenty-two reports of prevalence studies were identified. Eight population-based prevalence studies used clinical validation and reported prevalence rates of open ulcers ranging from 0.12% to 1.1% of the population; the prevalence rate of open or healed ulcers was reported to be 1.8%. Seven population-based studies without clinical validation reported prevalence rates of open ulcers ranging from 0.12% to 0.32% of the population. Differences in the populations studied, study design, ulcer definition, ulcer etiology, inclusion of foot ulcers, method of clinical assessment, and clinical validation of ulcer cases indicate that it is inappropriate to pool the estimates of prevalence. In most studies that considered age and sex, the prevalence of ulcers increased with age and was higher for women. CONCLUSIONS: Better-quality prevalence studies are needed. These studies should clearly define the populations being studied, include large numbers of individuals and total populations, provide a clear definition of an ulcer, describe case identification procedures, and clinically confirm the presence of ulcers.

Age Distribution↗
PubMed2003

Assessing venous ulcer population characteristics and practices in a home care community.

To plan for a new community leg ulcer service in one Ontario region, venous ulcer population characteristics and current community care practices were obtained from a home care cohort of people with venous ulcers. A secondary analysis was conducted on the venous ulcer cohort using data collected during a Regional Prevalence and Profile Study. Patients were identified based on the clinical syndrome for venous disease criteria described in the Royal College of Nurses clinical practice guidelines and by the presence of an ankle-brachial pressure index 0.8. The Regional Prevalence and Profile Study identified 263 people with leg ulcers for a rate of 2.0 per 1,000 people >25 years of age. One hundred, seven ulcers (41%) were the result of venous disease; of these, 83 (78% of cases) were associated with a single nursing agency and formed the study cohort. Most patients (51, 61%) were female and 65 years old. Thirty-eight (46%) had 4 comorbid conditions, 63 spoke English, 29 lived alone, 38 did not require physical aids or assistance for mobility, and 81 (98%) were able to travel outside of their home. The current ulcer had been present for an average of 15 months (median 6 months), 51 participants had a previous leg ulcer, and 22 had episodes of ulceration for > 5 years. Of the 121 ulcers in the study, 48 (41%) were located at the ankle, and the majority (85%) were > 1 cm2. General practitioners were the main medical care providers for 48 participants, and 52 (62%) had seen a specialist physician for their current ulcer. These findings are similar to large studies conducted in other industrialized countries and confirm that venous ulcers are a chronic problem in a population with complex health needs.

Adult↗
PubMed2003

Knowledge and attitudes regarding care of leg ulcers. Survey of family physicians.

OBJECTIVE: To determine family physicians' perceptions of and attitudes toward leg ulcer care and awareness of effective treatments for venous leg ulcers. DESIGN: Self-administered, cross-sectional faxed and mailed survey. SETTING: Ottawa-Carleton, Ont. PARTICIPANTS: All physicians in the region who were members of the College of Family Physicians of Canada. RESULTS: Response rate was 62%. During 1 month, 107 physicians reported having 226 patients with leg ulcers; only a few patients had had ultrasound assessment. Few physicians (16%) were confident about managing leg ulcers; 61% reported not knowing enough about wound-care products. More than 50% were unaware that compression is effective treatment for venous ulcers. Problems reported were lack of evidence-based clinical practice guidelines for leg ulcer care (82%); absence of evidence-based protocols in home-care agencies (72%); lack of access to wound-care products (69%) and wound-care centres (66%); and poor communication among health care workers (60%). CONCLUSION: Better access to diagnostic assessments and use of compression therapy for venous leg ulcers would improve care.

Bandages↗
PubMed2002

Current home care expenditures for persons with leg ulcers.

OBJECTIVE: The purpose of this study was to gain a better understanding of the home care expenditures incurred in providing care to the population with leg ulcers. DESIGN: The study was designed as a descriptive survey and was conducted over a 4-week period during March 1999. SETTING AND SUBJECTS: Persons in a large Ontario urban center with an ulcer below the knee, including the foot, who were receiving nursing services in the home, were eligible for inclusion in the study. INSTRUMENTS: A leg assessment tool, a supply usage form, and a visiting nurses log (all developed by the researchers for the study) were used to collect data. METHODS: Home care nurses visited all clients and completed an in-depth assessment of their social, medical, and leg ulcer history. Legs were inspected, an ankle brachial pressure index score was determined, and ulcers were examined and measured. For each nursing visit, supply usage, travel and treatment times, and mileage were tracked. RESULTS: During the study period, 2270 visits were made (mean treatment time = 26 minutes, mean travel time = 17 minutes) costing $80.62 (Canadian dollars). Supply costs were $21.06. The regional annual home care expenditures were conservatively estimated to be $1.3 million. CONCLUSION: Costs could potentially be reduced by cutting the 40% visit time attributed to travel, decreasing the visit frequency to clients with minimal drainage, and attention to "best practice."

Cohort Studies↗
PubMed2002

Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition.

BACKGROUND: The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses. METHODS: A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge. RESULTS: At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 +/- 19.1 SD) than among the Usual Care patients (37.5 +/- 20.3 SD; P = 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P = 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (chi2 = 4.86, df 1, P = 0.03). CONCLUSIONS: There were significant improvements in health-related quality of life (HRQL) associated with Transitional Care and less use of emergency rooms.

Adult↗
PubMed2002

The process of developing best practice guidelines for nurses in Ontario: risk assessment and prevention of pressure ulcers.

Linking practice to current evidence-based wound care guidelines is a challenge for healthcare professionals, especially because of the quantity of wound care guidelines available. In 1999, the Registered Nurses Association of Ontario, Canada, with funding from the Province of Ontario's Ministry of Health and Long Term Care, established a process for the development and implementation of 17 best practice guidelines to support nurses using evidence-based practice. Four of the 17 guidelines pertain to wound care. The consensus development, pilot testing, and evaluation process of one of the guidelines, Risk Assessment and Prevention of Pressure Ulcers in Adults, is described. Following a comprehensive and systematic search for existing guidelines, a formal quality appraisal of five selected guidelines, decisions for adoption and/or adaptation of best practice recommendations, and stakeholder feedback on the draft guidelines, a pilot implementation testing of the guidelines was conducted. In early 2002, the nursing best practice guideline was disseminated through conferences, publications, and the Registered Nurses Association of Ontario website www.rnao.org.

Benchmarking↗
PubMedDate not supplied

Factors associated with pressure ulcers in adults in acute care hospitals.

OBJECTIVES: To identify and describe the relationship of factors associated with pressure ulcers in adults in acute care hospitals. DESIGN: Cross-sectional prevalence studies. SETTING: University teaching hospital. PATIENTS: Prevalence studies conducted from 1993 to 1995 with a total of 1992 subjects served as the derivation sample and a 1996 prevalence study with 581 subjects served as the validation sample. MAIN OUTCOME MEASURES: Pressure ulcers and the Braden risk assessment subscale scores. DATA ANALYSIS: Logistic regression analysis was used to derive a model that fit the data and performed well at identifying factors associated with pressure ulcers. Performance of the model, in terms of calibration, was statistically evaluated using the Hosmer-Lemeshow goodness-of-fit test. The effectiveness of the model, in terms of discrimination, was assessed by considering the cut-off values using 2 by 2 classification tables to measure the overall percentage of subjects correctly classified in the validation sample. MAIN RESULTS: Factors associated with pressure ulcers in adults in acute care hospitals were identified as age, male gender, sensory perception, moisture, mobility, nutrition, and friction/shear. Three interactions were also found to be associated with pressure ulcers; 2 interactions (age and sensory perception and moisture and sensory perception) were negatively associated and 1 interaction (nutrition and gender/male) was positively associated with pressure ulcers. The Hosmer-Lemeshow goodness-of-fit test for the derivation sample (0.76) and the validation sample (0.79) indicated that the model was well calibrated and a good fit. The overall percentage of subjects correctly classified using the validation sample was 88%, indicating that the model performed well. CONCLUSIONS: This study enhances the knowledge of the relationship of factors associated with pressure ulcers in adults in acute care populations and enhances the use and relative importance of particular Braden Scale subscales.

Acute Disease↗
PubMedDate not supplied

Nursing-sensitive outcomes data collection in acute care and long-term-care settings.

BACKGROUND: Most administrative databases do not contain good information about nursing-sensitive outcomes. OBJECTIVES: To determine (a) the reliability of the instruments measuring nursing-sensitive outcomes, (b) whether the outcome measures are sensitive to changes in patients' health, and (c) whether the outcome measures are associated with nursing interventions. METHODS: The sample consisted of 890 patients from acute care hospitals and long-term-care facilities. A repeated measures design was used. Functional status was assessed on admission and discharge using Minimum Data Set 2.0 items. Symptom (pain, nausea, dyspnea, fatigue) frequency and severity were assessed with 4-point and 11-point numeric scales, respectively. Therapeutic self-care was assessed on discharge from acute care. Nursing interventions were assessed by documentation review. RESULTS: The outcome measures demonstrated very good interrater reliability with weighted Kappa ranging from .64 to .93. The internal consistency reliability was high for functional status and therapeutic self-care. The outcome tools were sensitive to change in patient condition. Select nursing interventions were related to functional status, therapeutic self-care, and symptom outcomes. DISCUSSION: The findings suggest that nurses are able to collect data on nursing-sensitive patient outcomes in a reliable and valid way.

Aged↗