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PubMed2006

[Research into oral history related to the management of the first registered nursing home in Taiwan].

The "Nurses Law", promulgated in 1991, allows nurses to operate nursing care facilities (e.g., nursing homes, home care institutes). The opening in 1993 of Taiwan's first registered nursing home, the Chiang-Chin Foundation of Nursing Perspectives, under Dr. Min-Shih Du represents an important milestone in both nursing and long-term care in Taiwan. Using the oral history method, this research depicts and analyzes Chiang-Chin Foundation of Nursing Perspectives operation and management experiences over a period spanning 1993 through 2002. Research results can provide management knowledge and experience for nurses, managers, and administrators in the long-term care field. Results also provide reference for long-term care policy makers and nursing entrepreneurs, and may serve as a valuable record related to the development of nursing in Taiwan.

History, 20th Century↗
PubMed1998

Swedish gynecologists' and general practitioners' views on the climacteric period: knowledge, attitudes and management strategies.

AIMS: To investigate attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynecologists and general practitioners (GPs) in Sweden. MATERIAL AND METHODS: In 1996 a questionnaire was sent to all Swedish gynecologists (n=1323) and every third general practitioner (GP) (n=1397) regarding indications, contraindications, treatment regimens and their own (or their wives') use of estrogens. RESULTS: Answers were received from 53% of the GPs and from 80% of the gynecologists. Fifteen per cent of the GPs often considered it difficult to evaluate the advantages and disadvantages of hormone replacement therapy compared to 2% of the gynecologists (p<0.001). Almost 100% of the physicians considered hot flushes, night sweats and osteoporosis to be indications for HRT. Significantly more GPs compared to gynecologists (50% vs 24%) stated that estrogen increased the risk of developing a deep vein thrombosis. Significantly more GPs performed measurements of blood pressure, weight, lipoproteins and palpated the breasts before starting treatment and at the follow-up visits. Significantly more gynecologists performed pelvic examination, vaginal sonography, endometrial biopsy and mammography. Among the female doctors who were either postmenopausal or had climacteric symptoms 72% of the GPs and 88% of the gynecologists were current users of HRT (p<0.01). Corresponding figures for the wives were 68% vs 86% (p<0.001). CONCLUSION: As earlier contraindications to HRT nowadays have turned into indications it is reasonable that more GPs compared to gynecologists consider it difficult to evaluate advantages and disadvantages of HRT and more gynecologists than GPs took the first initiative to discuss HRT with their patients. The information that far more female doctors and doctors' wives, compared to the Swedish female population, were using HRT is important information when discussing HRT compliance with patients.

Adult↗
PubMed1999

Identifying the management development needs of senior executives in Iran's teaching hospitals.

This research paper reports the findings of the first comprehensive survey of senior executives in Iran's teaching hospitals. It is based on an analysis identifying the continuing professional development (CPD) needs of the total population of the two senior levels of teaching hospitals management-presidents of physician-managers and administrative-managers. Four key areas of management knowledge were selected as the focus of the need identification: operational; financial; human resource; and organization change. The findings reveal a pent up demand for introductory level, formal knowledge in all four areas of management theory, to complement and extend the practical experience they have acquired in managing the complex environment of teaching hospitals. The paper goes on to propose a curriculum design and overall framework of provision to meet these genuinely felt CPD needs.

Curriculum↗
PubMed1999

Brain power.

Most organizations are smarter than they think. It's just that the information is locked in file cabinets, databases and people's heads. Getting that information--and using it--is the hallmark of a top-flight organization. The task is more difficult than you might think. H&HN profiles your knowledge management resources that can help you tap the wealth of information trapped inside your organization.

Information Management↗
PubMed2001

Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients.

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received.

Adult↗
PubMedDate not supplied

Nurses's knowledge of heart failure education principles.

OBJECTIVE: The goal of this study was to determine nurses' knowledge of heart failure (HF) self-management education principles. DESIGN: The study was exploratory and descriptive and included a convenience sample. SETTING: Research took place in a large midwestern health care system that included a university-based hospital, community hospitals, and home or palliative care. SUBJECTS: Subjects included 300 nurses who provide care to patients with HF. OUTCOME MEASURE: The outcome measures included overall and topic specific perceptions of basic information important to HF self-management. Topics included diet, fluids or weight, signs or symptoms of worsening condition, medications, and exercise. INTERVENTION: A 20-item, true or false written survey was administered between February 2000 and April 2000. RESULTS: Of the 300 nurses surveyed, 92% were registered nurses and 8% were licensed practical nurses; 38% worked in a large university-based hospital; 44% were employed at 5 community hospitals; and 18% worked in home or hospice-palliative care. Mean HF self-management knowledge score was 15.2 +/- 2.0. Registered nurses scored significantly higher than licensed practical nurses (15.3 vs 14.1; P =.004). Individual questions with overall scores <30% were related to dry or ideal weight in daily weight monitoring (24%), nonsymptomatic, low blood pressure (26%), and short-term dizziness when rising (19%). Individual question scores >30% and < or =75% were related to nonsteroidal anti-inflammatory inhibitor use (49%), potassium-based salt substitute use (52%), rest vs activity (72%), and lean delicatessen meat use in a low sodium diet (75%). In questions with scores <30%, nurses requested more information only 5% to 8% of the time. Overall analysis of variance indicated differences by work experience. HF nurses (primary population) scored higher than critical-care, medical-surgical, or telemetry floor nurses (16.2 +/- 1.7; 15.1 +/- 1.8; and 14.7 +/- 2.0, respectively; P <.001); home care nurses scored higher than hospital or palliative care nurses (15.9 +/- 1.5; 15.1 +/- 2.0; and 14.0 +/- 1.5, respectively; P =.006). CONCLUSION: Nurses may not be properly educated in HF self-management principles and must be provided with the right information so they can improve the quality and amount of information they offer to patients. Nurses who are better prepared to educate patients with HF may be more likely to carry out this nursing function as a part of their daily job role.

Adult↗
PubMed2000

Building telemedicine systems for supporting decisions in diabetes care: a report from a running experience.

This paper describes some issues that should be investigated to implement telemedicine systems designed for effectively supporting decisions in diabetic patients management, namely situation assessment, information sharing, and knowledge management. The solutions and experiences carried on in this field within a European Union (EU)-funded project, called T-IDDM (Telematic Management of Insulin Dependent Diabetes Mellitus), are reported.

Blood Glucose↗
PubMed2006

Decision support, knowledge representation and management in medicine.

OBJECTIVES: Clinical decision-support systems (CDSSs) are being recognized as important tools for improving quality of care. In this paper, we review the literature to find trends in CDSSs that were developed over the last few decades and give some indication of future directions in developing successful, usable clinical decision-support systems. METHODS: We searched PubMed for papers that were published during the past five years with the words Decision Support Systems appearing in the title and used our own knowledge of the field for earlier work. RESULTS: The goals of developers of modern CDSSs are to develop systems that deliver needed information and could be integrated with the healthcare's organizational dynamics. Such CDSSs form part of knowledge-management activities that healthcare organizations employ in order to excel. During the past few decades, we have witnessed a gradual maturation of knowledge representation formalisms and the needed infrastructure for developing integrated CDSSs, including electronic health record systems (EHR), standard terminologies, and messaging standards for exchange of clinical data. The demand for CDSSs that are effective and that will evolve as circumstances change gave rise to methodologies that guide developers on the construction and evaluation of CDSSs. CONCLUSION: Although there exist many approaches for representing, managing and delivering clinical knowledge, the design and implementation of good and useful systems that will last and evolve are still active areas of research. The gradual maturation of EHR and infrastructure standards should make it possible for CDSSs implementers to make major contributions to the delivery of healthcare.

Decision Making, Computer-Assisted↗
PubMedDate not supplied

Nurses' and doctors' knowledge of pain after surgery.

AIM: To analyse the links between levels of acute pain management knowledge, perceptions of clinical skills and the acute pain management education history of doctors and nurses working in orthopaedics and general surgery in an acute hospital. METHOD: Questionnaires were sent to 101 doctors and nurses. Eighty two were returned. Questions were derived from an abridged version of McCaffery and Ferrell's (2002) Nurses' Knowledge and Attitudes Survey Regarding Pain, acute pain literature and the trust's clinical standards and protocols. RESULTS: The results identified the most useful sources of acute pain management education and who accessed these; barriers to good acute pain management, other than a lack of education; differences between doctors and nurses in standards of education, levels of perceived competence and knowledge in assessment, pharmacology and analgesic delivery systems. CONCLUSION: Staff and patient misconceptions, inadequate sources of learning and professional traditions continue to affect the quality of acute pain management. However, progress has been made in the trust to overcome these factors through collaborative practice, review of education programmes and specific practice development initiatives.

Health Knowledge, Attitudes, Practice↗
PubMed1997

A survey of pediatric critical care nurses' knowledge of pain management.

BACKGROUND: Although nurses are accountable for pain management, it cannot be assumed that they are well informed about pain. Nurses' knowledge base underlies their pain management; therefore, it is important to measure their knowledge. OBJECTIVE: To measure pediatric critical care nurses' knowledge of pain management. METHOD: A descriptive, exploratory study was done. After a pilot study, an investigator-developed Pain Management Knowledge Test was distributed to 50 pediatric ICU nurses. Test responses were collected anonymously and coded by number. Item analysis was done, and descriptive statistics were calculated. Modified content analysis was used on requests for pain-related information. RESULTS: The test return rate was 38%. The overall mean score was 63%. Mean scores within test subsections varied from 50% to 92%. Other mean scores were 85% on a nine-item scale of drug-action items and 92% on a two-item scale of intervention items. However, no nurse recognized that cognitive-behavioral techniques can inhibit transmission of pain impulses; only 32% indicated that meperidine converts to a toxic metabolite, only 47% recognized nalbuphine as a drug that may cause signs and symptoms of withdrawal if given to a patient who has been receiving an opioid; and only 63% indicated that when a child states that the child has pain, pain exists. Thirteen nurses requested pain-related information, and all requests focused on analgesic medications. CONCLUSIONS: Testing nurses' knowledge of pain indicated gaps that can be addressed through educational interventions. Research is needed in which the test developed for this study is used as both pretest and posttest in an intervention study with pediatric critical care nurses or is modified for use with nurses in other clinical areas.

Adolescent↗
PubMed2005

A GIS-based protocol for the collection and use of local knowledge in fisheries management planning.

Despite a heavy reliance on scientific knowledge as the primary source of information in resource management, many resources are in decline, particularly in fisheries. To try and combat this trend, researchers have drawn upon the knowledge of local resource users as an important supplement to scientific knowledge in designing and implementing management strategies. The integration of local knowledge with scientific knowledge for marine species management, however, is problematic stemming primarily from conflicting data types. This paper considers the use of spatial information technology as a medium to integrate and visualise spatial distributions of both quantitative scientific data and qualitative local knowledge for the purposes of producing valid and locally relevant fisheries management plans. In this context, the paper presents a detailed protocol for the collection and subsequent use of local knowledge in fisheries management planning using geographic information systems (GIS). Particular attention is paid to the use of local knowledge in resource management, accuracy issues associated with the incorporation of qualitative data into a quantitative environment, base map selection and construction, and map bias or errors associated with the accuracy of recording harvest locations on paper map sheets, given the complications of map scale.

Animals↗
PubMedDate not supplied

Developing clinical practice environments supporting the knowledge work of nurses.

Registered nurses represent the largest group of healthcare knowledge workers. They accomplish their knowledge work by engaging in the roles of data gatherer, information user, knowledge user, and knowledge builder. To successfully implement these roles, nurses rely on healthcare settings to provide supportive clinical practice environments that recognize their information and knowledge management needs. The authors describe the various knowledge-worker roles, delineate computerized mechanisms that can support these roles, and examine the ability of current healthcare settings to provide an environment conducive to successful knowledge-worker role performance. The article concludes with specific recommendations for development of clinical practice environments supportive of nurses' knowledge work.

Decision Making, Computer-Assisted↗
PubMed1997

Application of the problem-based learning model for continuing professional education: a continuing medical education program on managed care issues--Part II.

Physicians must incorporate concepts of practice management and knowledge of managed care into their practices. Managed care presents an immediate and challenging opportunity to providers of continuing medical education to offer effective educational programs for physicians on managed care issues. In this exploratory research, the problem-based learning model was used to develop a continuing medical education program that would offer an interactive and effective method for teaching physicians about managed care. Problem-based learning is a departure from the traditional lecture format of continuing medical education programs because it is designed for small groups of self-directed learners who are guided by a faculty facilitator. Although only a small number of participants participated in this program, the findings offer important considerations for providers of continuing medical education. For example, participants reported increased confidence in their knowledge about managed care issues. Participants also clearly indicated a preference for the small group, interactive format of the problem-based learning model.

Education, Medical, Continuing↗
PubMed1990

Computer-assisted techniques for evaluation and treatment of hypertensive patients.

An integrated approach, progressively implemented in the ARTEMIS system since 1975, is described for the computerized management of hypertensive patients. From a medical point of view, computerized programs can be used to memorize patients' individual records and profiles, to facilitate patient management and follow-up, to store medical knowledge about hypertension and to provide facilities for decision making at the level either of the individual patient or of the population followed up. From a technical point of view, the methodology used integrates data and knowledge management facilities into the same software. Five hypertension clinics are presently using the system in France and more than 22,000 records have been registered. Answer rates to 12 mandatory questions regarding past history and examination at first visit were superior to 95% in 19,601 records created between January 1976 and December 1987. Patient database interrogation can be used to evaluate the sensitivity and specificity of various signs and symptoms for the diagnosis of secondary hypertension, and to predict, for each patient, his/her cardiovascular risk, the risk of drop-out, the risk of insufficient blood pressure control and the probable blood pressure level. It also serves to test the content and validity of the associated expert system which is progressively built up. A prospective evaluation of the performance of the expert system on 80 cases of hypertension showed overall agreement between the specialists and the expert system ranging from 58 to 91% depending on the decision.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

A knowledge audit of the managers of primary care organizations: top priority is how to use routinely collected clinical data for quality improvement.

Technology has provided improved access to the rapidly expanding evidence base and to computerized clinical data recorded as part of routine care. A knowledge audit identifies from within this mass of information the knowledge requirements of a professional group or organization, enabling implementation of an appropriately tailored knowledge-management strategy. The objective of the study is to describe perceived knowledge gaps and recommend an appropriate knowledge-management strategy for primary care. The sample comprised 18 senior managers of Primary Care Trusts: the Chairman, Chief Executive Officer, or Research and Development Lead. A series of interviews were recorded verbatim, transcribed and analysed. Knowledge requirements were broad, suggesting that a broadly based knowledge-management strategy is needed in primary care. The biggest gap in current knowledge identified is how to perform needs assessment and quality improvement using aggregated routinely collected, general practice computer data.

Data Collection↗
PubMed1999

WAX ActiveLibrary: a tool to manage information overload.

WAX Active-Library (Cambridge Centre for Clinical Informatics) is a knowledge management system that seeks to support doctors' decision making through the provision of electronic books containing a wide range of clinical knowledge and locally based information. WAX has been piloted in several regions in the United Kingdom and formally evaluated in 17 GP surgeries based in Cambridgeshire. The evaluation has provided evidence that WAX Active-Library significantly improves GPs' access to relevant information sources and by increasing appropriate patient management and referrals this might also lead to an improvement in clinical outcomes.

Artificial Intelligence↗
PubMed2001

Tasmanian nurses' knowledge of pain management.

The aim of this research was to obtain information concerning knowledge of the pain management practices of Tasmanian nurses. We examined the knowledge of Tasmanian Registered Nurses in relation to pain management issues such as addiction, use of analgesics and the assessment of pain. In addition, we queried them about their satisfaction with information they had received about how to manage pain in both workplace programs and in their initial education. A total of 2768 registered nurses were mailed a 29-item survey examining knowledge of pain management practices. One thousand and fifteen valid surveys were returned. Mean scores on the knowledge questions (72% correct) of the survey revealed deficits in knowledge. Nurses specifically lacked up-to-date knowledge concerning the pharmacological management of pain, but displayed a more up-to-date knowledge concerning the effect of patient variables on pain perception. Nurses also rated the information they received about pain management during workplace programs as poor, feeling that they acquired significantly more in-depth information during their initial education. The results of this study have implications for institutions involved in both patient pain management and pain management education.

Adult↗