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Biomedical subjects

R A Crow

Publications and source records attributed to R A Crow.

18 recordsLinked to original sources
PubMed1996

Overview and critique of judgement and decision making in health care: social and procedural dimensions.

This paper presents an outline of the scope for the application of decision theory to health care. Firstly, the main approaches to and assumptions of decision theory are discussed. Secondly, health care decision making is reviewed. It is noted that decision theory can be applied to either the health care professional or to the lay person. Applications of decision theory to clinical practice, to the management of care and to resourcing are considered. Thirdly, some areas which would repay further research are identified. These include social processes in individual and group decision making, the temporal distribution of outcomes and the development of techniques capable of dealing with the complex and dynamic features of decisions. On the basis of the foregoing, some conclusions are drawn.

Decision Making↗
PubMed1996

Judgements and processes in care decisions in acute medical and surgical wards.

The decisions which health care professionals make are the basis of treatment and care given. In order to evaluate effective care it seems logical to suggests that an awareness of the decisions which health care professionals make and how they make them is needed. This study examines the processes nurses use when making decisions about the health care needs of acutely ill patients. In stage one, 104 qualified nurses were interviewed to identify how they decide health care needs. In stage two, a 'think aloud' technique was used with patient simulations to obtain verbal protocols from a further 55 qualified nurses to identify the information strategies they used when making these decisions. The results suggest that nurses base their health care decisions mainly on their assessment of qualitative patient states or conditions. Initial indications are that the processes used differ from those characterized in the diagnostic reasoning model, with the context in which decisions are made being an important influence together with nurses' experience. It is suggested that, in order to develop effective predictive models and clinical guidelines which aid decision making, more research into the nature of health care professionals' decision making is carried out.

Critical Care↗
PubMed1995

The cognitive component of nursing assessment: an analysis.

This paper presents an analysis of the cognitive component of nursing assessment, complimenting the growth in knowledge of other important aspects of assessment. The purpose of the paper is to provide a framework for understanding how nurses structure assessment problems and the types of judgements they make. The thrust of the analysis is based on a comparison between nursing assessment and medical diagnosis, since the cognitive component and judgements formed in medical diagnosis have been more fully articulated. The results suggest that there may be similarities between the cognitive strategies used in nursing assessment and those used in medical diagnosis, particularly in relation to the gathering and organization of information. But the purpose of the information search appears to be different. In medical diagnosis the aim is to establish an explanation for the patient's presenting problem. In nursing assessment, on the other hand, the aim appears to be to provide an accurate picture of the patient's current condition or situation. The assessments formulated fit the definition of a judgement and, in common with medical diagnoses, include some form of prediction. Unlike the medical diagnoses, however, which usually remain stable throughout treatment, the assessments need to change as the patient's condition changes. The cognitive component of assessment has significant implications for nurse education and clinical practice. Further understanding of how nurses structure assessment problems and formulate judgements is therefore needed. The findings may also help to clarify the meaning of nursing diagnosis.

Cognition↗
PubMed1989

Measurement of soft tissue thickness over the sacrum of elderly hospital patients using B-mode ultrasound.

The thickness of soft tissues over the sacrum of elderly hospital in-patients has been measured using B-mode ultrasound. Forty patients were scanned, of which nine had recognizable superficial pressure sores at the sacrum. No correlation was found between the depth of soft tissue and either age or Norton score. Patients with sores had less soft tissue over the sacrum (p less than 0.025). Excluding one patient whose sacral sore appeared to be the final stage of the healing process, the remaining eight all had less than 8.5 mm of sacral soft tissue cover. Five patients without sacral sores also had less than 8.5 mm of sacral soft tissue cover. However, a combination of the presence of incontinence and the depth of sacral soft tissue cover identified seven of the eight patients with sacral sores with no inclusion of patients without sores.

Aged↗
PubMed1989

Biofilms, bacteria and bladder catheters. A clinical study.

Biofilms were present on 16 of 33 urethral catheters examined. In 11 cases the catheter carried a different microbial flora from that of the bladder urine. The length of time the catheter was in situ did not influence biofilm formation, and all types of materials tested supported biofilm growth. Biofilms were seen on 2 of the 7 catheters where prophylactic antibiotics had been used.

Bacteria↗
PubMed1988

Nursing procedures and their function as policies for effective practice.

Documents covering nursing procedures form part of the District Health Authorities policies in the United Kingdom. How far such written documents contribute to standards of care has not been established. As part of a wider investigation, a postal survey of all District Health Authorities in England and Wales was undertaken to examine the content of procedures for catheter care. Eighty-two per cent of Authorities responded and it was found that the documents consisted largely of a detailed list of steps to be followed. There was no complete coverage of all components of care and there were gaps in information concerned with patient safety. In discussion it is suggested that procedures reflect technical performance rather than guidelines for good practice. In the light of this analysis it is argued that the profession should reconsider the place of such documents within the Health Authorities' quality assurance programme.

Catheters, Indwelling↗
PubMed1988

Bacteriuria during indwelling urethral catheterization.

The incidence of bacteriuria and the risk factors related to its acquisition were determined in a prospective study of 220 hospitalized patients. Bacteriuria was recorded in 97/220 (44%) of patients, in 42 cases within 48 h (Group A) and in 55 cases more than 48 h (Group B) after catheterization. The results of a multivariate analysis of Group A demonstrated that the reason for catheterization, the use of antimicrobial chemotherapy and the medical specialty of care were the only variables of those assessed associated with the acquisition of bacteriuria. In a similar analysis of Group B the number of days the catheter was in situ and the use of antimicrobial chemotherapy were the only factors which achieved statistical significance.

Adolescent↗
PubMed1981

Research and the standards of nursing care: what is the relationship?

Research and standards of nursing care are looked at to see in what way they are inter-related. The label "standards of care' is said to embrace several meanings: the quality of care and the measures against which the care can be judged. For research, it is argued, concepts must be clearly defined before they can be the subject of serious study. It is thus essential that the different meanings implied by standards are separated out. After discussion on this point, whereby the different components are analysed, quality of care, standards of care and effectiveness of care are illustrated through their inter-relationship. It is then suggested that the contribution of research to standards used as measures against which care can be judged may be either to indicate which criteria could comprise useful measures, or to indicate the limitations and constraints of the measures chosen for use.

Denmark↗
PubMed1980

Maternal behavior during breast- and bottle-feeding.

Filmed records of an entire feeding session of a population of breast-and bottle-fed human infants were made at approximately 1-month intervals. The occurence of maternal and infant behavior is related to the infant's birth weight during the first week of life only in bottle-fed infants; the greater the mother's response, the less the small infant consumes. There are clear behavioral differences between bottle- and breast-feeding which stem from inherent characteristics of the technique of feeding. Breast-feeding allows the infant to have more control during the feed, whereas in the bottle-feeding, the mother has more control. This concept of control is discussed in terms of its implications for somatic growth and the development of obesity in relation to the advice and training of health professionals.

Birth Weight↗
PubMedDate not supplied

The shape up challenge: a community-based worksite exercise competition.

PURPOSE: To assess organizational and employee participation during three community-wide worksite exercise competitions in two communities. DESIGN: A one-group, posttest-only design was used. Lack of controls, exercise baseline, and the short-term nature of the interventions were limitations. SETTING: The Minnesota Heart Health Program conducted annual exercise campaigns between 1982 and 1989 within three intervention communities to reduce behavioral risk for cardiovascular disease. The Shape Up Challenge was a worksite exercise competition designed, in conjunction with other campaign activities, to increase levels of physical activity. SUBJECTS: A total of 119 participating companies in two Minnesota communities, and 17,626 employees within these worksites, composed the subjects in this study. INTERVENTION: Eligible worksites were invited to participate in a month-long competition during which employees recorded minutes spent daily in aerobic activities. Incentives were established to promote intragroup cooperation and intergroup competition. Companies competed for awards that were based on average minutes of exercise per employee versus per participant. MEASURES: Numbers of companies recruited and participating, campaign activities, minutes of exercise, and costs were recorded on implementation logs. Companies completed surveys describing business type, number and sex of employees, existing health promotion programs, and perceived benefits of participation. RESULTS: Of the 365 companies invited to participate, 33% participated (range 15% to 50%). Participating companies were more likely than nonparticipating companies to offer other health promotion programs and perceived greater benefits from participation. Women and smaller companies had significantly greater participation rates than men and larger companies. Average employee participation rates ranged from as high as 84% in smaller organizations to as low as 16% as organization size increased. CONCLUSIONS: Community-based worksite exercise competitions appear to be a viable strategy for promoting employee exercise, particularly in smaller companies. Group-based contingencies applied in natural work units may facilitate employee participation. Further research is needed to assess the relative efficacy of this approach, compare alternative incentives, and identify strategies to enhance exercise maintenance after the intervention has ceased.

Chi-Square Distribution↗