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Biomedical subjects

S B Henry

Publications and source records attributed to S B Henry.

At least 19 recordsLinked to original sources
PubMed1995

Critical care information systems: essential infrastructure for critical care nursing practice.

In the three decades since the installation of the first bedside computer in the "shock ward" at the University of California and Los Angeles County Hospital, both computer technology and critical care practice have evolved rapidly. The premise of this article is that critical care information systems are an essential infrastructure for critical care nursing practice. This premise is described in terms of the critical care environment, clinical decision making in critical care, increasing demands for information about quality and costs, and national initiatives for the sharing of health care information.

Critical Care↗
PubMed1994

The relationship between type of care planning system and patient outcomes in hospitalized AIDS patients.

The purpose of this study was to describe the problems of HIV-infected patients, hospitalized for Pneumocystis carinii pneumonia (PCP), as documented in the nursing care plan and to examine differences in the number and type of activated patient problems and patient outcomes between manually generated, computer-supported, and standardized care planning systems. Of the sample, 22% had no care plan. In the computer-supported care planning system the fewest number of care plans were completed. The total number of problems generated for the 89 patients having care plans was 199. The problems were categorized as PCP-related (37%), AIDS-related (16%), psychosocial (23%), knowledge deficit (14%), and other (10%). There were significant differences among the three groups in the total number of problems, PCP-related problems, and knowledge deficit problems. There were no statistically significant differences in patient outcomes, as measured by HIV-QAM scale scores and patient self-rating of physical condition approximately 1 week after admission, and length of stay among the three care planning systems. Future research is needed to examine the effect of type of care planning system on the quality of patient care.

AIDS-Related Opportunistic Infections↗
PubMed1994

Can SNOMED International represent patients' perceptions of health-related problems for the computer-based patient record?

As the United States moves towards a computer-based patient record, there is much discussion related to the contents of such a record and the manner in which the data elements will be represented. Recent health care reform has emphasized the need for increased patient involvement in health care decision making, however, there has been little discussion about including the patient perspective in the computer-based patient record. Using an existing data set of 201 patients who were hospitalized for Pneumocystis carinii pneumonia, this study examined the ability of SNOMED International to represent patients' perceptions of health-related problems. The majority of concepts used by patients to describe health-related problems could be matched with existing SNOMED terms. The addition of the social context module as an adjunct to existing terminologies of medical diagnoses, NANDA diagnoses, and signs/symptoms provided additional matching terms. Patient goals did not match existing SNOMED terms. The findings of this study suggest that SNOMED International has the potential to adequately represent patients' perceptions of health-related problems for the computer-based patient record. Additional studies are needed that will examine the extent to which patients' perceptions of health-related problems are already documented in the patient record by healthcare providers. The utility of patients' perceptions of health-related problems in the prediction of patient outcomes must also be analyzed.

Attitude to Health↗
PubMed1993

AIDS2: a decision-support tool for decreasing physicians' uncertainty regarding patient eligibility for HIV treatment protocols.

We have developed a decision-support tool, the AIDS Intervention Decision-Support System (AIDS2), to assist in the task of matching patients to therapy-related research protocols. The purposes of AIDS2 are to determine the initial eligibility status of HIV-infected patients for therapy-related research protocols, and to suggest additional data-gathering activities that will decrease uncertainty related to the eligibility status. AIDS2 operates in either a patient-driven or protocol-driven mode. We represent the system knowledge in three combined levels: a classification level, where deterministic knowledge is represented; a belief-network level, where probabilistic knowledge is represented; and a control level, where knowledge about the system's operation is stored. To determine whether the design specifications were met, we presented a series of 10 clinical cases based on actual patients to the system. AIDS2 provided meaningful advice in all cases.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Representation of nursing terms for the description of patient problems using SNOMED III.

We conducted an experiment to determine if the terms recorded by nurses in the patient chart to describe patient problems could be represented using SNOMED III terms. The data sources for the patient problems were the nurses' progress notes and nursing care plans from 485 patient encounters in three diverse settings (NR02215). We entered the nursing terms into a relational database. We loaded the SNOMED III terms into a relational database and created a word index. We determined matches by identifying the English description of the SNOMED III term that best matched the term charted by the nurses. Sixty-nine percent of the nursing terms in the test subset were matched using one or more SNOMED III terms. We identified redundant SNOMED III terms for several nursing terms including fear and diarrhea. Our results suggest that terms recorded by nurses in the patient chart can be represented using SNOMED III terms. Further enhancement and refinement will improve the domain completeness of SNOMED III as a controlled healthcare vocabulary and decrease redundancies.

Humans↗
PubMed1992

Patients' perceptions of pulmonary problems and nursing interventions during hospitalization for Pneumocystis carinii pneumonia.

BACKGROUND AND METHODS: The descriptive, correlational study examined patients' perceptions of pulmonary problems and nursing interventions in a sample (n = 201) of persons living with AIDS hospitalized for Pneumocystis carinii. Additionally, the study assessed differences in physiological variables, patient symptoms, and functional status based on the type of problems identified: dyspnea, pulmonary problems without dyspnea, and nonpulmonary problems. RESULTS: A total of 601 problems was identified including 61 instances of dyspnea and 83 reports of other pulmonary problems. The remainder of the problems was nonpulmonary. Nursing interventions associated with dyspnea and pulmonary problems other than dyspnea were mainly broadly defined interventions such as oxygen and medication administration. When patients were placed into three groups based on identification of dyspnea, pulmonary problems without dyspnea, or only nonpulmonary problems, there were no differences between groups in functional status or patient symptoms of pain, nausea, or fatigue as measured by the Quality Audit Marker. CONCLUSIONS: This study demonstrated that hospitalized patients with Pneumocystis carinii present with a broad array of problems. Contrary to expectations, dyspnea was not ubiquitous but was reported by less than one-third of this sample. When dyspnea was present there were few independent nursing interventions that patients identified. Studies are needed to test effective strategies for the nursing management of dyspnea and a large variety of other patient problems associated with HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1992

Computerized clinical simulations: a strategy for staff development in critical care.

BACKGROUND: Identifying the learning needs of employees and evaluating the results of staff development offerings are essential elements of the responsibilities of the staff development educator. High patient acuity, the shortage of critical care nurses, and rapidly changing technology within the critical care environment demand the provision of staff development offerings that are appropriate for the learning needs of critical care nurses and the evaluation of the effect of programs on critical care nursing practice. OBJECTIVE: The purposes of this descriptive, correlational study were to compare the ability of a knowledge test, a self-evaluation tool, and computerized clinical simulations to discriminate between nurses with varied levels of knowledge and experience, and to compare the learning needs identified from the three types of evaluative instruments. METHODS: Each subject (n = 142) completed the Basic Knowledge Assessment Tool for Critical Care, Cardiovascular Self-Evaluation Tool, and four computerized clinical simulations. RESULTS: Both the Basic Knowledge Assessment Tool and the Cardiovascular Self-Evaluation Tool discriminated between experienced/inexperienced and Advanced Cardiac Life Support-certified/noncertified critical care nurses. The computerized clinical simulations discriminated according to Advanced Cardiac Life Support certification, but not between experienced and inexperienced critical care nurses. The computerized clinical simulations identified more specific learning needs than did the Basic Knowledge Assessment Tool or Cardiovascular Self-Evaluation Tool. CONCLUSIONS: The evidence for discriminant validity, adequate internal consistency reliability, and ease of administration supports the continued use of these two tools as methods for critical care staff development needs assessment and evaluation. In addition, the study findings support the use of computerized clinical simulations as an adjunct to other needs assessment and evaluation methods in nursing staff development.

Adult↗
PubMed1992

A needs analysis for computer-based telephone triage in a community AIDS clinic.

This study describes the complexity of the telephone-triage task in a community-based AIDS clinic. We identify deficiencies related to the data management for and documentation of the telephone-triage encounter, including inaccessibility of the medical record and failure to document required data elements. Our needs analysis suggests five design criteria for a computer-based system that assists nurses with the telephone-triage task: (1) online accessibility of the medical record, (2) ability to move among modules of the medical record and the triage-encounter module, (3) ease of data entry, (4) compliance with standards for documentation, and (5) notification of the primary-care physician in an appropriate and timely manner.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Critical care management of the patient with HIV infection who has Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) is the most frequently occurring opportunistic infection in individuals infected with the human immunodeficiency virus. Improved methods of diagnosing and treating PCP have resulted in increased survival rates. Nurses are more frequently faced with treatment of the critical care patient with PCP. Knowledge about the mechanisms and manifestations of PCP as well as its diagnosis and treatment provides a baseline for the nursing management of PCP. Nursing care for the critically ill adult patient with PCP focuses on the management of the human responses to PCP including hyperthermia, impaired gas exchange, altered respiratory function, fatigue, and altered nutrition, and on the management of the side effects of treatment including nausea, vomiting, and hypoglycemia. Effective interventions related to these patient problems can improve the quality of care and ultimately affect patient outcomes.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Nursing care plans for people with HIV/AIDS: confusion or consensus?

Examination of four standardized nursing care plans for people with AIDS (PWAs) from four agencies with extensive experience with caring for PWAs revealed that there is little agreement about the nursing care problems of PWAs. Differences in language, conceptual clarity, and level of complexity related to problem identification have implications for nursing practice, quality assurance and research. Without consensus about patient problems, it is impossible to communicate effectively about nursing care problems for PWAs. Research is needed to validate patient problems that can serve as the basis for standards of care and provide guidance for nurses inexperienced in caring for PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Nurses' perspectives on problems of hospitalized PCP patients: implications for the development of a nursing taxonomy.

The phenomena of interest in nursing informatics research are the data, information and knowledge related to nursing. This study presents nurses' perspectives on the problems of patients hospitalized for Pneumocystis carinii pneumonia from four data sources: nurse interview, intershift report, care plan, and nurses' notes. Even within this narrowly specified sample, patient problems showed variation across sources of data. The results of this study demonstrate the difficulties inherent in developing a nursing taxonomy when there is not consensus about the relevant data for nursing within a specific patient sample. Although existing information technology is capable of processing large volumes of nursing data, the lack of a common taxonomy limits the usefulness of the technology for documentation of care and decision support applications.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Clinical decision making of critical care nurses managing computer-simulated tachydysrhythmias.

The purposes of this study were to describe the clinical decision making of critical care nurses managing computer-simulated tachydysrhythmias and to assess the major sources of error related to the management of two tachydysrhythmias: atrial flutter and ventricular tachycardia. In this descriptive study, 142 critical care nurses each completed four computerized clinical simulations (two atrial flutter and two ventricular tachycardia). Simulation performance was measured by proficiency score (comparison with expert performance), patient outcome (cure or die), and amount of data collected before the first intervention. Mean proficiency scores were 51% for atrial flutter and 35% for ventricular tachycardia. Thirteen percent of the atrial flutter and 35% of the ventricular tachycardia simulations ended in patient death. Failure to recognize ventricular tachycardia and unfamiliarity with second- and third-line treatments were major sources of error. Medication errors were the cause of death in 87% of the simulations ending in patient death. These results document the need for emphasis on dysrhythmia management in the critical care curriculum.

Arrhythmias, Cardiac↗
PubMed1991

Effect of level of patient acuity on clinical decision making of critical care nurses with varying levels of knowledge and experience.

This study is an examination of the effect of patient acuity on the clinical decision making of critical care nurses (N = 68) completing two computerized clinical simulations. Ventricular tachycardia represented the high-acuity situation and atrial flutter the lower-acuity situation. Clinical decision making was measured by proficiency score, patient outcome (cure or die), and amount of data collected. Analyses of variance were conducted to examine proficiency score and the amount of data collected. Fisher's exact test and the McNemar test of homogeneity of proportions were used to examine patient outcome. In the atrial flutter simulation, proficiency scores were higher (p = 0.000), more dysrhythmias were cured (p less than 0.005), and more data were collected (p = 0.040). Experienced and inexperienced nurses did not differ on proficiency score; however, inexperienced nurses collected more data (p = 0.048) and cured fewer atrial flutter simulations (p = 0.040). Nurses certified in advanced cardiac life support had higher proficiency scores (p = 0.033) and collected fewer data (p = 0.048).

Acute Disease↗
PubMed1989

The effect of verbalization of cognitive processes on clinical decision making.

Although verbalization of cognitive processes is a common strategy in the study of clinical decision making, the effect of verbalization on performance has not been adequately assessed. The effect of verbalization of cognitive processes on performance on a computer-assisted clinical simulation was examined using a three-group experimental design. Sixty pediatric nurses were randomly assigned to one of three groups (n = 20/group): instructions to think aloud, instructions to recall decision processes, or no instructions to verbalize. The experimental groups did not differ on proficiency or efficiency scores on the computerized clinical simulation. Two-way analyses of variances revealed no main or interaction effects when examining type of verbalization instructions by level of education, years of pediatric experience, or case familiarity, suggesting that there was no apparent effect of verbalization of cognitive processes on performance regardless of level of expertise. These findings support the continued use of verbalization of cognitive processes as a strategy to examine clinical decision making.

Clinical Competence↗
PubMedDate not supplied

Problems of persons with HIV/AIDS hospitalized for Pneumocystis carinii pneumonia.

The authors of this prospective study describe the problems of persons living with HIV/AIDS hospitalized for Pneumocystis carinii pneumonia (PCP) (N = 90) and examine how the problems change over time. Data were obtained from four sources and were classified into major problem categories. The largest mean number of problems were reported in the category of PCP. Specific psychosocial problems were more likely to be reported in the patient and nurse interviews than in the chart and intershift report. The study findings validate the physical symptoms addressed in the published care plans and guidelines for caring for patients with PCP. The study identified the limitation of using the patient record as the only data source in determining nursing care needs and emphasized the importance of the patients perspective.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Terms used by nurses to describe patient problems: can SNOMED III represent nursing concepts in the patient record?

OBJECTIVE: To analyze the terms used by nurses in a variety of data sources and to test the feasibility of using SNOMED III to represent nursing terms. DESIGN: Prospective research design with manual matching of terms to the SNOMED III vocabulary. MEASUREMENTS: The terms used by nurses to describe patient problems during 485 episodes of care for 201 patients hospitalized for Pneumocystis carinii pneumonia were identified. Problems from four data sources (nurse interview, intershift report, nursing care plan, and nurse progress note/flowsheet) were classified based on the substantive area of the problem and on the terminology used to describe the problem. A test subset of the 25 most frequently used terms from the two written data sources (nursing care plan and nurse progress note/flowsheet) were manually matched to SNOMED III terms to test the feasibility of using that existing vocabulary to represent nursing terms. RESULTS: Nurses most frequently described patient problems as signs/symptoms in the verbal nurse interview and intershift report. In the written data sources, problems were recorded as North American Nursing Diagnosis Association (NANDA) terms and signs/symptoms with similar frequencies. Of the nursing terms in the test subset, 69% were represented using one or more SNOMED III terms.

Delivery of Health Care↗
PubMedDate not supplied

Informatics: essential infrastructure for quality assessment and improvement in nursing.

In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is supported by 1) presentation of a historical perspective on quality assessment and improvement; 2) delineation of the types of data required for quality assessment and improvement; and 3) description of the current and potential uses of information technology in the acquisition, storage, transformation, and presentation of quality data, information, and knowledge.

Computer Communication Networks↗