Nurses' behaviors and visual scanning patterns may reduce patient identification errors.

Patient identification (ID) errors occurring during the medication administration process can be fatal. The aim of this study is to determine whether differences in nurses' behaviors and visual scanning patterns during the medication administration process influence their capacities to identify patient ID errors. Nurse participants (n = 20) administered medications to 3 patients in a simulated clinical setting, with 1 patient having an embedded ID error. Error-identifying nurses tended to complete more process steps in a similar amount of time than non-error-identifying nurses and tended to scan information across artifacts (e.g., ID band, patient chart, medication label) rather than fixating on several pieces of information on a single artifact before fixating on another artifact. Non-error-indentifying nurses tended to increase their durations of off-topic conversations—a type of process interruption—over the course of the trials; the difference between groups was significant in the trial with the embedded ID error. Error-identifying nurses tended to have their most fixations in a row on the patient's chart, whereas non-error-identifying nurses did not tend to have a single artifact on which they consistently fixated. Finally, error-identifying nurses tended to have predictable eye fixation sequences across artifacts, whereas non-error-identifying nurses tended to have seemingly random eye fixation sequences. This finding has implications for nurse training and the design of tools and technologies that support nurses as they complete the medication administration process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Candida parapsilosis fungemia in cancer patients--incidence, risk factors and outcome

OBJECTIVES: To evaluate the results of an ergonomic-educational course for nurses we assessed the number and percentage of harmful postures and of ergonomic and biomechanical errors made before and after the course. We also studied the perceived physical exertion. MEANS AND METHODS: In all, 12 nurses who had participated in the course (trainees) and 12 who had not (controls) were recorded on video while performing standardized nursing tasks. The wards from which the two groups of nurses came were comparable, as were the patient populations. The nurses were also comparable in some personal characteristics. The tasks they performed included washing, lifting, and repositioning a patient as well as certain tasks other than patient handling. Video recordings were made once before (1-2 weeks) and twice after the course (after 3 months and after 15 months). The harmful postures, the errors made, and the ratings of perceived exertion were measured by means of the Ovako Working-posture Analysis System (OWAS), a checklist, and Borg scores, respectively. RESULTS: When the first and last measurements of all the above tasks taken as a whole were analyzed the trainees showed a significant improvement in the number and percentage of harmful postures and errors, whereas the controls did not. The same could be concluded for lifting alone. After the course the new work routine did not appear to have caused any extra perceived physical exertion. CONCLUSION: It can be concluded that the course was successful, although it should be carefully investigated as to whether nurses remain capable of working safely in daily practice. The work pressure that nurses experience during their normal duties could prevent them from working safely during everyday work.     

African bats: evolution of reproductive patterns and delays

Nurses administer medications every day as part of their practice. Consequently, many studies have explored nurses and the part they play in medication administration. The focus of these studies has often been limited, concentrating on nurses and drug errors, rather than on incorporating a broader view of nurses and the medication administration process in general. In an attempt to broaden the focus of the discussion about nurses and medication administration, this study used Critical Incident Technique (C.I.T.) to identify registered nurses' perceptions of factors affecting the quality administration of medications in their practice setting. Five categories of themes emerged as having an impact on nurses and the administration of medications: the context, the procedures, the groups of professionals involved, the personal attributes of individual staff, and the client. Implications of the research for nursing education and practice are discussed.     

Lexical access in aphasic and nonaphasic speakers.

An interactive 2-step theory of lexical retrieval was applied to the picture-naming error patterns of aphasic and nonaphasic speakers. The theory uses spreading activation in a lexical network to accomplish the mapping between the conceptual representation of an object and the phonological form of the word naming the object. A model developed from the theory was parameterized to fit normal error patterns. It was then "lesioned" by globally altering its connection weight, decay rates, or both to provide fits to the error patterns of 21 fluent aphasic patients. These fits were then used to derive predictions about the influence of syntactic categories on patient errors, the effect of phonology on semantic errors, error patterns after recovery, and patient performance on a single-word repetition task. The predictions were confirmed. It is argued that simple quantitative alterations to a normal processing model can explain much of the variety among patient patterns in naming. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Usefulness of the protection motivation theory in explaining hearing protection device use among male industrial workers.

The present study examined the usefulness of personal variables: noise annoyance, and components of the protection motivation theory (R. W. Rogers, 1983) along with social-organizational factors in explaining hearing protection device (HPD) use among Israeli manufacturing workers. Participants were 281 men exposed to harmful noise levels for which routine HPD use is required by regulation. In practice, 3 HPD user groups were identified: nonusers (n?=?38), occasional users (n?=?125), and regular users (n?=?118). HPD use was objectively verified. HPD use was primarily related to the personal variables but not to management pressure, coworker pressure, or family support. The most powerful predictors of HPD use were perceived self-efficacy (for long-term HPD use), perceived susceptibility (to hearing loss), and noise annoyance, together explaining 48% of the outcome variance. These findings have implications for interventions aimed at motivating workers to use HPDs regularly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group treatment of depression: Individual predictors of outcome.

The present study attempted to identify patient characteristics predictive of individual outcome in a psychoeducational group treatment for unipolar depression. Forty participants meeting Research Diagnostic Criteria for depressive disorders were assessed on demographic and psychological variables at both pre- and posttreatment and on participation variables during treatment. The treatment modality was the Coping With Depression Course. At the end of treatment, 85% of the subjects no longer met diagnostic criteria for depressive disorders. A stepwise multiple regression analysis attained a multiple correlation of .92, accounting for 85% of the variance in posttreatment depression level. Ten variables accounted for significant portions of the outcome variance beyond that explained by pretreatment Beck Depression Inventory scores. The results of previous studies were partially replicated; predictive ability was improved markedly over prior reports. The results suggest that the most robust predictors of outcome are pretreatment levels of depression, social functioning, perceived mastery over events, and early positive perceptions of group cohesiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in spatial ability and activity in two vole species (Microtus ochrogaster and M. pennsylvanicus).

The hypothesis that sex differences in maze learning result from sex differences in activity was tested with wild-caught prairie (Microtus ochrogaster) and meadow (M. pennsylvanicus) voles. For 38 voles error production and activity were simultaneously measured in a series of 7 symmetrical mazes. Repeated-measures analyses of variance (ANOVAs) examined species, sex, maze, and interaction effects for 3 dependent variables: errors, activity, and errors/activity. The pattern of significant effects was very different for the errors and activity ANOVAs, which suggests that differential activity cannot explain differential error rates. In contrast, the pattern of effects was very similar for errors and errors/activity ANOVAs, which suggests that controls for activity do not remove differences in error production. These results fail to support the activity hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How to avoid mistakes in medicine administration

This article examines factors that may contribute to errors in drug administration. These can range from the omission of a single dose of a non-essential drug to a major overdose resulting in serious harm to a patient. It concludes that a combination of being observant and well-informed can help to prevent errors.     

Managing occupational HIV exposures: a Canadian study

The findings reported in this paper are part of a larger study that explored how nurses cope with the risk of acquiring HIV infection while caring for persons with AIDS (PWAs). The data were collected through in-depth interviews with 13 nurses who cared for PWAs in a large Western Canadian hospital. Seven of these nurses perceived that they had been exposed to HIV-infected blood or body fluids. This paper describes how these seven nurses coped with actual exposures to HIV-infected blood or body fluids. Data were analyzed using the methodology of grounded theory. Nurses' coping efforts after exposure were grouped into four categories: minimizing the effect of exposures, reducing a sense of vulnerability, selective disclosure to others, and assigning meaning. Nurses minimized the physical effects of exposure through measures such as 'bleeding' the needlestick injury and immersing the affected area in bleach solution. Nurses reduced their sense of vulnerability by assessing the possibility of harm, avoiding situations that aroused fear, and confronting the decision for HIV testing. Nurses limited their disclosures to co-workers to avoid rejection and to preserve professional self-esteem. Disclousre to significant others was influenced primarily by the support nurses perceived they would receive. Finally, nurses attempted to assign meaning to the exposure by determining why the event occurred and by evaluating the implications it has had on their lives. The article concludes with implications for nursing practice.     

Optimizing drug therapy based on genetic differences: implications for the clinical setting

Differences in drug responses due to gene alterations are rapidly being identified. Gene alterations may inhibit the function of an enzyme so that an active drug accumulates, causing adverse reactions with normal doses. Alternatively, gene alterations may accelerate enzymatic function so that an active drug is rapidly eliminated, causing subtherapeutic responses to normal doses. Mutations and polymorphisms have been identified that affect a person's response to many currently prescribed medications including cardiovascular, anti-infective, chemotherapeutic, psychiatric, and analgesic drugs. The potential exists for drug therapy to be optimized by selecting medication and doses based on a person's genotype rather than by trial and error. In the near future, advanced practice nurses in the acute care setting may be expected to order, provide patient education about, and explain results of genetic tests before initiating a specific drug therapy. Advanced practice nurses must be knowledgeable about what genetic tests are analyzing and their benefits, limitations, and risks.     

Effectiveness of computer-assisted instruction in increasing the rate of universal precautions--related behaviors

BACKGROUND: With widespread noncompliance to universal precautions well established, an experimental study was designed to compare the rate of universal precautions--related behaviors between nurses who participate in computer-assisted instruction. This study also explored the relationship between rates of universal precautions--related behaviors and subjects' demographic and experiential characteristics and history of occupational blood-borne exposure. METHODS: Data were collected by using a questionnaire to elicit information as to subjects' demographic and experiential characteristics and history of occupational blood-borne exposure. The Universal Precautions Assessment Tool was used to gather data on rates of universal precautions--related behaviors on two groups of registered nurses with 30 subjects per group. RESULTS: By using analysis of variance, the null hypothesis was rejected. The intervention used in this study did increase universal precautions--related behaviors. Multiple regression was used to analyze the research question and none of the variables were significant. Forty (67.8%) subjects reported receiving a needlestick or cut caused by a needle or sharp that was actually or potentially contaminated with blood or body fluids. Of these exposures, only one patient was known to be HIV antibody positive. CONCLUSION: Replication studies using computer-assisted instruction interventions are needed as are studies aimed at exploring other potentially effective interventions.     

Effect of feeding quandong (Santalum acuminatum) oil to rats on tissue lipids, hepatic cytochrome P-450 and tissue histology

The authors examined the role of perceived family support and symptoms of depression as predictors of survival in a sample of 78 in-center hemodialysis patients. Cox regression analysis revealed significant effects for family support (p < .005), blood urea nitrogen (p < .01), and age (p < .005). The effect for depression was not significant. The Cox model indicated that a 1-point increase on the family support measure was associated with a 13% reduction in the hazard rate (i.e., mortality). Estimated 5-year mortality rates among low family support patients were approximately 3 times higher than estimated mortality for high support patients. Differences in patient adherence to the dietary and medication regimens failed to explain the significant effect of family support.     

Rational errors and the mathematical mind.

What do errors reveal about the mathematical mind? Intriguingly, errors are often logically consistent and rule based rather than being random. Investigating errors, therefore, presents an opportunity for uncovering the mental representations underlying mathematical reasoning. A useful question is whether errors break down into different categories or types. If this were the case, then one could explain a variety of seemingly different problem-solving behaviors by using only a few principles. The aim of this article is to provide a taxonomy of rule-based errors in mathematical reasoning that illustrates how a few basic mental processes may be responsible for generating myriad different errors. Implications for general processes of reasoning and problem solving are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of exercise intention and behavior during and after phase 2 cardiac rehabilitation: An application of the theory of planned behavior.

Objective: To evaluate the theory of planned behavior (TPB) as a framework for understanding exercise motivation during and after Phase 2 cardiac rehabilitation (CR). Design and Participants: Patients (57 men and 24 women) completed a TPB questionnaire that included attitudes, subjective norms, perceived behavioral control, and exercise intentions pre- and post-Phase 2 CR. Results: During Phase 2 CR, regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 38% of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. At postrehabilitation follow-up, attitudes, subjective norm, and PBC explained 51 % of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. Conclusion: The TPB is a useful framework for understanding exercise intentions and behavior both during and after Phase 2 CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

British medical undergraduates in 1975: a student survey in 1975 compared with 1966

At a time in a large community mental health center when all adjunct facilities were geared for crises, the compelling determinants in those patients still requiring hospitalization were studied. It was found that all patients answered affirmatively to one or more of the following six categories as occurring in their prehospital life: 1) alcohol abuse; 2) other drug abuse; 3) suicidal attempt; 4) a recent loss; 5) stoppage (or reduction) of medication; 6) stoppage of outpatient treatment. It was found that those patients diagnosed schizophrenic (69 per cent) did not significantly differ in the number of affirmative answers given in each of the six categories when compared to the total patient population. The most frequent categories to which an affirmative answer was given were stoppage of medication and stoppage of outpatient treatment. There did appear to be a trend for various combinations of these categories in a give patients. The schizophrenic group tended to have more affirmative answers in combinations of categories 3 and 4. The importance of these findings in the hospitalization and follow-up treatment of psychiatric patients is discussed.     

An account of the systematic error in judging what is reachable.

An account of the postural determinants of perceived reachability is proposed to explain systematic overestimations of the distance at which an object is perceived to be reachable. In this account, these errors are due to a mapping of the limits of prehensile space onto a person's perceived region of maximum stretchability, in the context of a whole-body engagement. In support of this account, 6 experiments on the judged reachability of both static and dynamic objects are reported. We tentatively conclude that the mental imagery of action is grounded and calibrated in reference to multiple skeletal degrees of behavioral freedom. Accordingly, this calibration is a source of systematic error in reachability judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)