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Biomedical subjects

P H Mitchell

Publications and source records attributed to P H Mitchell.

16 recordsLinked to original sources
PubMed1990

Validation of risk factors for the nursing diagnosis decreased intracranial adaptive capacity.

Mitchell has proposed a series of factors that may aid in the identification of individual patients with intracranial hypertension at risk for decreased intracranial adaptive capacity. The etiology of decreased intracranial adaptive capacity is failure of normal intracranial compensatory mechanisms. The defining characteristic of this nursing diagnosis is repeated disproportionate increase in intracranial pressure (ICP) that can occur in response to a variety of noxious and nonnoxious stimuli. The purpose of this study was to determine predictive validity of two risk factors (wide amplitude of ICP tracing and increased level of ICP at rest) for the phenomenon of decreased intracranial adaptive capacity. Data were derived from secondary analysis of 30 recordings from a sample of eight children who had ICP monitoring as part of their medical treatment. Results indicated that wide amplitude of ICP tracing or wide amplitude plus increased level of ICP at rest (specificity and positive predictive value were each 100%) with suctioning and turning was more likely to be associated with a disproportionate increase in ICP than when an increased level of ICP at rest alone was the only risk factor (specificity = 25% and positive predictive value = 67% with suctioning and specificity and positive predictive value each = 40% with turning). It was also concluded that, despite high positive predictive values, the combination of risk factors was sufficient but not solely necessary for a disproportionate increase in ICP (false negative predictive value for wide amplitude was 65% with suctioning and false negative predictive value for increased level of ICP was 83% with suctioning and 43% with turning).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1989

American Association of Critical-Care Nurses Demonstration Project: profile of excellence in critical care nursing.

The American Association of Critical-Care Nurses developed a Demonstration Project to document fiscal costs and patient care effectiveness of critical care nursing in a unit characterized by valued organizational attributes. Data were collected by interview, observation, and written surveys from 42 nurses, 68 physicians, and 192 patient admissions. Decentralized administration, participatory management, high rate of CCRN certification, all-registered nurse staff, and high nurse-physician collaboration were present. Organizational and clinical outcomes were positive: high satisfaction, low turnover, low mortality ratio, no new complications, high patient satisfaction. The proportion of charges for nursing-controlled factors was low compared with proportion of total stay spent in the unit. Aspects of structure, process, and outcome can be measured simultaneously in critical care; these measurements indicate that positive organizational and clinical outcomes coexist with valued aspects of the organizational environment.

Costs and Cost Analysis↗
PubMed1987

The generic videodisc: an innovative technology in nursing education.

Generic videodisc is a resource that we have used to expand the clinical experience available to students in a specialized graduate curriculum. The versatility of this resource has made it equally valuable to undergraduate students, as well as students and professionals in other health-related disciplines. In contrast to usual media, the general disc has no fixed message that limits its use to one philosophy or educational objective. Educators and learners can tailor this resource to their own goals.

Curriculum↗
PubMed1986

Decreased adaptive capacity, intracranial: a proposal for a nursing diagnosis.

A new nursing diagnosis is proposed related to failure of normal intracranial compensatory mechanisms manifested by repeated disproportional increases in ICP in response to noxious and nonnoxious stimuli. This diagnosis, decreased adaptive capacity--intracranial, occurs in patients with intracranial hypertension. It is not synonymous, however, with increased intracranial pressure (ICP). Rather, its use in the patient with intracranial hypertension allows the nurse to identify who is at high risk for disproportionate increase in ICP and decrease in cerebral perfusion pressure (CPP) secondary to ordinary activities of nursing care. The diagnosis can guide nursing management to reduce adaptive demands and increase adaptive capacity in those patients.

Adaptation, Physiological↗
PubMed1986

Intracranial hypertension: influence of nursing care activities.

Although there has been concern that a variety of nursing care procedures may serve as potent adaptive demands in patients with intracranial hypertension, research shows that activities such as bathing, oral hygiene, touching, and suctioning produce relatively small increases in ICP and are accompanied by adequate CPP. Head rotation and flexion are potent stimuli to increased ICP, although CPP has remained adequate in the small number of people in whom it has been measured. While considerable descriptive work has been done with respect to a variety of nursing care activities, much remains to be done. Little is known about the mechanisms by which activities (turning and suctioning) effect demands upon the craniospinal system, nor what the best predictors are of individuals who will respond adversely to such demands. The potential of affective touch and environmental sensory stimulation to reduce ICP and reduce the need for potent pharmacologic agents is intriguing but has not been adequately explored. Further investigators need to attend to reporting individual as well as group patterns to guide clinical application and describe predictors of individual response. In addition, the oscillatory nature of ICP and cardiovascular variables needs to be taken into account in interpreting whether or not "real" change has occurred in response to given activities. The full range of cerebrovascular variables needs to be measured to determine if changes in ICP pose a threat to cerebral perfusion. Finally, we need to examine nursing therapeutics with respect to ultimate outcomes (functional recovery) as well as to individual care activities.

Adaptation, Physiological↗
PubMedDate not supplied

Problem-oriented recording as a teaching-learning tool.

The assumption that problem-oriented records help teach critical thinking was tested by co-paring clinical recordings and case study data for a group of beginning nursing students who were taught problem-oriented charting with a group who were taught traditional charting. No differences were found between the groups in the mean number of patient problems identified from a case situation. However, in clinical charting, the problem-oriented group identified significantly more patient problems and had significantly higher quality-of-organization scores. Assuming the case situation and clinical situation were equivalent in presentation of identifiable problems, these findings suggested that the problem-oriented format was superior in allowing students to demonstrate their ability to identify and solve patient problems.

Education, Nursing, Baccalaureate↗
PubMedDate not supplied

Perspectives on human response to health and illness.

Nursing's domain has been defined as the diagnosis and treatment of human responses to health problems, yet debate rages over what "human responses" are. Without clear meanings for this and other terms used in nursing, the profession cannot claim that its practice is scientifically based, nor can it share that base among disciplines.

Adaptation, Physiological↗
PubMedDate not supplied

The crisis of the health care nonsystem.

Far from being the best in the world, the United States' cure-oriented patchwork of fee-for-service service medical care has left 37 million American citizens without access to health care. The new public debate on health care reform gives nurses an opportunity to transform this ineffective market-oriented medical model into a universal, true health care system.

Attitude to Health↗
PubMedDate not supplied

Relationship of patient-nurse activity to intracranial pressure variations: a pilot study.

Persons with increased intracranial pressure (ICP) from all causes are subject to periods of markedly increased pressure. Research since the initial clinical studies in the early 1960s has focused primarily on characteristics of ICP variations in specific pathologies and on mechanisms basic to increases in ICP rather than on the relationship between basic patient-care activities, such as moving the patient in bed, and variations in ICP. Therefore, nine patients with pressure-controlled ventriculostomy drainage systems were observed continuously for up to 24 hours to determine whate, if any, patient-nurse activities were associated with transient of sustained increased ICP. Frequencies of ventricular fluid drainage (VFD) during activity and nonactivity were compared to predicted frequencies. One patient had no VFD; eight patients had greater than predicted incidence of VFD associated with activity and less than predicted incidence associated with nonactivity. The difference between predicted and actual incidence of VFD was statistically significant (p less than .001) for all eight patients. Although each patient displayed individual patterns of specific activity associated with VFD, turning in bed and conversation about the patient's condition were consistent among the sample. Coughing, chewing use of bedpan, and restless movemenss were consistently associated with VFD in patients.

Adaptation, Physiological↗