Decision support for patient preference-based care planning: effects on nursing care and patient outcomes.
OBJECTIVE: While preference elicitation techniques have been effective in helping patients make decisions consistent with their preferences, little is known about whether information about patient preferences affects clinicians in clinical decision making and improves patient outcomes. The purpose of this study was to evaluate a decision support system for eliciting elderly patients' preferences for self-care capability and providing this information to nurses in clinical practice-specifically, its effect on nurses' care priorities and the patient outcomes of preference achievement and patient satisfaction. DESIGN: Three-group quasi-experimental design with one experimental and two control groups (N = 151). In the experimental group computer-processed information about individual patient's preferences was placed in patients' charts to be used for care planning. RESULTS: Information about patient preferences changed nurses' care priorities to be more consistent with patient preferences and improved patients' preference achievement and physical functioning. Further, higher consistency between patient preferences and nurses' care priorities was associated with higher preference achievement, and higher preference achievement with greater patient satisfaction. CONCLUSION: This study demonstrated that decision support for eliciting patient preferences and including them in nursing care planning is an effective and feasible strategy for improving nursing care and patient outcomes. (+info)
Case mix adjustment in nursing systems research: the case of resident outcomes in nursing homes.
Case mix indicates, for a resident population, the degree of risk for developing favorable or unfavorable outcomes. In a study of 164 nursing homes, we explored two methods for combining resident assessment data into a case mix index (CMI). We compared a facility-level, composite CMI to a prevalence-based CMI comprised of 22 separate resident characteristics for their adequacy in explaining resident outcomes. The prevalence-based CMI consistently explained more variance in outcomes than the facility level, composite CMI. This study indicates a reasonable method for using administrative databases containing resident assessment data to adjust for the influence of case mix on nursing home resident outcomes. (+info)
How should patients consult? A study of the differences in viewpoint between doctors and patients.
BACKGROUND: Increasing pressure on limited NHS resources has led to the introduction in primary care of a skill mix which seeks to match clinical presentation to an intervention based on skills and training. There has also been increasing emphasis on the use of telephone consultations. However, outcomes on the benefits of these different approaches may be difficult to obtain and process variables such as the views of patients may be important. OBJECTIVE: The objective of the study was to answer the following questions (i) how many existing GP consultations do doctors and patients assess as being suitable for consultation with a specially trained nurse or for telephone advice from a doctor?; (ii) do doctors and patients share similar views on the suitability of individual cases?; and (iii) do these assessments differ between acute, chronic and urgent cases? METHOD: A sample of 750 patients comprising of 150 patients attending for booked consultation with each of five doctors were interviewed prior to the consultation and asked whether they would be happy to see a specially trained practice nurse or if their problem could be dealt with by a doctor on the telephone. For each case the GP gave his response. A similar study was undertaken with 150 'extras' patients who needed to be seen urgently and who could not wait for an appointment the following day. The viewpoint of the GP was compared with that of the patient. RESULTS: GPs felt that 20% of all booked cases could be seen by a nurse compared with the patients' assessment of 29%. These figures were higher for acute booked cases (30 and 34%) and for urgent extras (44 and 58%). There was a poor agreement between the viewpoints of doctor and patient especially for chronic booked cases although this agreement increased with the more acute presentations. The number of cases that could be dealt with on the telephone ranged from 5 to 9% with poor agreement between doctor and patient. CONCLUSION: This study extends the findings of a number of others which indicate that patients can be seen satisfactorily by nurses, and that both doctors and patients see scope for increasing the number of consultations dealt with by nurses. Booked patients with chronic presentations and urgent extras are more likely than their doctors to think that they could be dealt with by the nurse. This may be due to a difference in perspective between doctors and patients about the outcome they hope to achieve in the consultation. Further qualitative work is needed to explore these differences and to clarify the best approach to this expanding area. (+info)
Is care of the dying improving? The contribution of specialist and non-specialist to palliative care.
OBJECTIVES: To identify and synthesize evidence from studies examining the quality of care of dying patients in both specialist and general practitioner care. METHOD: Review of published research identified by online and manual searches. RESULTS: Three large, population-based surveys were identified, carried out between 1969 and 1990, and five randomized controlled trials of specialist palliative care programmes. There were, in addition, a small number of comparative studies and a large volume of descriptive, qualitative material. Some studies identified major methodological problems and the overall quality was poor. Most research concerned selected patients with neoplasms, particularly in settings where specialist palliative care teams are available. There was minimal information about the care of patients dying from non-neoplastic conditions. CONCLUSIONS: There is limited evidence of improvements in the care of selected cancer patients, and a dearth of evidence concerning patients dying from other, more common causes. The methods of research used to date are of limited current utility and new methods are required. (+info)
The virtue of nursing: the covenant of care.
It is argued that the current confusion about the role and purpose of the British nurse is a consequence of the modern rejection and consequent fragmentation of the inherited nursing tradition. The nature of this tradition, in which nurses were inducted into the moral virtues of care, is examined and its relevance to patient welfare is demonstrated. Practical suggestions are made as to how this moral tradition might be reappropriated and reinvigorated for modern nursing. (+info)
Clothing for use in clean-air environments.
Disposable plastic two-piece suits were compared with conventional cotton suits, gowns, and plastic aprons by nurses in a burns unit. The plastic suits allowed fewer micro-organisms to be dispersed into the environment than the other garments but were less comfortable. (+info)
Effect of hospital asthma nurse appointment on inpatient asthma care.
While asthma nurses are funded by many health authorities within the U.K. National Health Service, for the improvement of clinical management in both inpatient and outpatient settings in secondary care, the effect of asthma nurse appointment on acute asthma care in hospitalized children has been inadequately studied. Here, we test the hypothesis that the employment of a full-time hospital asthma nurse improves quality of care for children admitted to hospital with acute asthma. Prospective in design, the study compares analyses of indicators of good clinical practice for hospitalized asthmatic children (2-16 yrs) before and after the appointment of a hospital asthma nurse. Both management [oxygen saturation check (35/106 vs. 111/126, P<0.05)] and discharge planning [self management plan/asthma education (17/106 vs. 49/126, P<0.05), follow-up arrangements with general practice (8/106 vs. 25/126, P<0.05)] improved. There was, however, no significant change in oral steroid administration, peak flow check, inhaler technique assessment, inhaled drug prophylaxis or arrangements for hospital follow-up at discharge. Employment of a hospital-based children's asthma nurse leads to significant improvement in aspects of routine in-patient asthma management. However, other important areas of in-patient asthma care did not improve following nurse-led interventions. A clearer evidence base may improve compliance with asthma management guidelines, and could make the role of hospital asthma nurse more effective. (+info)
Comparing response time, errors, and satisfaction between text-based and graphical user interfaces during nursing order tasks.
Despite the general adoption of graphical users interfaces (GUIs) in health care, few empirical data document the impact of this move on system users. This study compares two distinctly different user interfaces, a legacy text-based interface and a prototype graphical interface, for differences in nurses' response time (RT), errors, and satisfaction when the interfaces are used in the performance of computerized nursing order tasks. In a medical center on the East Coast of the United States, 98 randomly selected male and female nurses completed 40 tasks using each interface. Nurses completed four different types of order tasks (create, activate, modify, and discontinue). Using a repeated-measures and Latin square design, the study was counterbalanced for tasks, interface types, and blocks of trials. Overall, nurses had significantly faster response times (P < 0.0001) and fewer errors (P < 0.0001) using the prototype GUI than the text-based interface. The GUI was also rated significantly higher for satisfaction than the text system, and the GUI was faster to leam (P < 0.0001). Therefore, the results indicated that the use of a prototype GUI for nursing orders significantly enhances user performance and satisfaction. Consideration should be given to redesigning older user interfaces to create more modern ones by using human factors principles and input from user-centered focus groups. Future work should examine prospective nursing interfaces for highly complex interactions in computer-based patient records, detail the severity of errors made on line, and explore designs to optimize interactions in life-critical systems. (+info)