The barriers and benefits of nursing information systems

Nursing informatics is a growing field with many opportunities for nursing involvement. Because nurses are involved increasingly in the design, installation, and use of nursing information systems (NIS) it is important that they are aware of the barriers to and benefits of nursing information systems. This article describes the evolution of nursing information systems and the design goals for current systems. The lack of a unified nursing language and individual and organizational factors such as characteristics of the nurse, the unit, the administrative philosophy, and workload issues are discussed as barriers to NIS development. Increased nurse involvement, education, research, and recognition of the benefits of computerization are suggested to overcome the barriers. A review of the literature provides the reader with evidence of improved efficiency, patient safety and satisfaction, and ability to measure quality as benefits of NIS. Areas for further research are identified: outcomes measurement using NIS, decision support and expert systems, point-of-care documentation, interagency and interdisciplinary communication, and further work on individual and organizational factors.     

Putting psychiatric nursing standards into clinical practice

1. The nursing service of a 640-bed acute care teaching hospital consistently put standards of care and practice into actual nursing care by implementing a computerized nursing care plan (NCP) system. 2. Staff nurses worked with clinical specialists to write/revise standards for their specialty areas. These facility specific standards of care and practice were incorporated into the computerized NCP system. 3. The result of the computerization was legible NCPs in only a few minutes. These NCPs direct patient care based on generic and specialty nursing practice standards and promote equitable care for all patients.     

Constructional perspectives in clinical assessment.

The constructional approach to assessment and treatment refers to broad metatheoretical assumptions regarding the value of constructing rather than eliminating behavioral repertoires. The attempt to move from a deficit-oriented model to one that emphasizes a client's assets and strengths is discernible in a variety of orientations. In this article, a general paradigmatic framework is advocated that represents positive and negative behaviors in the context of interactions between characteristics of the social environment and the organization of individual behavioral repertoires. By emphasizing the interrelationships within repertoires, a rationale is provided for conceptualizing and assessing positive behaviors. The significance of positive behaviors for the design of long-term, effective interventions is presented along 3 dimensions: judgment of the meaningfulness of therapy outcome, the use of personal and social supports in the process of therapeutic change, and values regarding clients' potential. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distribution of single-dose drugs. Reflection on nursing practice

The nurse, as a member of the staff, is supposed to take responsibility on the administration of medicines as one of the important duties among all the activities he/she has to perform. The implementation of the distribution system of only-dose medicine is directly bound to nurses' activities. Therefore, this study has as its main purpose to detect nurses' reflections about the system and their impact on nursing practice. The authors questioned the way the nurse and his/her staff are inserted in this context of changes, in a way of really assuring benefits for the patients, following and evaluating the whole process, considering that such change affects directly part of these activities.     

AIDS in older people. A literature review for clinical nursing research and practice

Older Americans, 50 years of age and older, account for 10% of the 400,000 reported cases of AIDS nationwide (Centers for Disease Control and Prevention, 1994). the integrated literature review format in this article examines the published literature on HIV/AIDS in older adults. Most articles are case studies and reports, with only 17% having a research basis. The information reviewed indicates that older adults have different risk factors than younger populations for contracting HIV disease and a different pattern of disease progression. These differences create a need for knowledge of HIV infection and AIDS and its parameters in aging populations so nurses may provide both timely and appropriate care.     

Logotherapy for clinical practice.

Logotherapy is based on the meaning-focused existential philosophy of Viktor E. Frankl (1905-1997). Numerous mental health professionals have been inspired by his most popular book, Man's Search for Meaning; however, many are unfamiliar with the depth of Frankl's work. The purpose of this article is to discuss the tenets of logotherapy, including fundamental concepts, applicability and techniques, roles of the therapist, and assessment tools and new research findings. Logotherapy can readily be integrated with techniques that mental health professionals frequently use, and thus it has much to offer mental health professionals regardless of their theoretical orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Human and clinical perspectives on leptin

The neurochemical coding of neurones located in ganglia of the nerve trunk accompanying the chicken ureter was analysed and quantified using NADPH-diaphorase reactivity and immunohistochemistry against tyrosine hydroxylase (TH), nitric oxide synthase (NOS), calbindin (CAL), vasoactive intestinal polypeptide (VIP), neuropeptide Y (NPY), somatostatin (SOM), substance P (SP) and calcitonin gene-related peptide (CGRP) in untreated or colchicine-treated preparation. Almost all neurones were either positive for TH (38%) or for SOM (60%). Only 4% of the neurones were both TH- and SOM-positive and 3% of the neurones exhibited neither TH nor SOM immunoreactivity. The relative numbers of NPY-, NOS-, CAL- and VIP-positive neurones were 57%, 28%, 14% and 7%, respectively. No SP- or CGRP-positive neurones were observed. All NADPH-diaphorase-positive neurones expressed NOS immunoreactivity. Only in some TH-positive neurones was NPY and/or NOS found. Four major subpopulations were found in the ureteric ganglia. The SOM-positive neurones were subdivided into SOM/NPY/NOS- (28% of all neurones), SOM/NPY- (18%) and SOM/CAL/NPY-positive neurones (14%). A subpopulation of these peptid- ergic neurones also contained VIP. About 35% of the neurones contained TH only. Neurones of all subpopulations (72% of the neurones), except most of the CAL-positive neurones, were encircled by dense plexus of varicose SP/CGRP-positive, presumably sensory nerve fibres. Dense plexus of VIP-positive fibres were observed around 89% of the neurones. The chemical coding of the neuronal subpopulations identified in the ganglia accompanying the chicken ureter resembled that observed in the ganglia of Remak's nerve but was remarkably different from that of the autonomic neurones described in mammalian species.     

Parish nursing: advancing practice nursing. Model for healthier communities

Data on glomerular capillary capsular epithelia differentiation and proliferation from d 18 of embryogenesis until birth in normal conditions and after protamine sulfate administration to pregnant female rats are presented. The correlation between proliferation and differentiation processes at the stages studied was established. Pathogenic influence on pregnant female rats are presented. The correlation between proliferation and differentiation processes at the stages studied was established. Pathogenic influence on pregnant rat exerted through mother-placenta system impairs differentiation of glomerular filtration barrier components in progeny.     

Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research

OBJECTIVE: To determine the suitability of insurance claims information for use in clinical outcomes research in ischemic heart disease. DESIGN: Concordance study of two databases. SETTING: Tertiary care referral center. PATIENTS: A total of 12,937 consecutive patients hospitalized for cardiac catheterization for suspected ischemic heart disease between July 1985 and May 1990. INTERVENTIONS: Two-by-two tables were used to compute overall and kappa measures of agreement comparing clinical versus claims data for 12 important predictors of prognosis in patients with ischemic heart disease. MEASUREMENTS: Kappa statistics (agreement adjusted for chance agreement) were used to quantify agreement rates. RESULTS: Agreement rates between the clinical and claims databases ranged from 0.83 for the diagnosis of diabetes to 0.09 for the diagnosis of unstable angina (kappa values). Claims data failed to identify more than one half of the patients with prognostically important conditions, including mitral insufficiency, congestive heart failure, peripheral vascular disease, old myocardial infarction, hyperlipidemia, cerebrovascular disease, tobacco use, angina, and unstable angina, when compared with the clinical information system. CONCLUSIONS: Our results suggest that insurance claims data lack important diagnostic and prognostic information when compared with concurrently collected clinical data in the study of ischemic heart disease. Thus, insurance claims data are not as useful as clinical data for identifying clinically relevant patient groups and for adjusting for risk in outcome studies, such as analyses of hospital mortality.     

Enhancing clinical practice: The role of practice guidelines.

Health service researchers believe that significant practice variations occur, in part, because there is no strong consensus on best practices for managing a specific condition. The Agency for Health Care Policy and Research supports the development of science-based clinical guidelines, performance measures, and standards of quality. Since 1992, it has published 6 clinical guidelines and is supporting development of more than 20 others. Each has a consumer version, in English and Spanish, to educate patients and describe care options. Widespread use of these guidelines will improve the quality of health care by assisting providers in making more informed decisions, thereby reducing unnecessary health care practices; will reduce some costs; and will provide feedback on knowledge gaps that merit the attention and support of researchers and policymakers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

静脉留置针的临床应用及护理体会

静脉留置针作为一种新技术,正日益广泛地在我院的临床护理中应用.其操作简单,安全方便,既解决了患者反复穿刺的痛苦,保护了静脉,又减轻了护士的护理工作量,适合于老年患者及无自主意识的患者,特别是危重患者,可随时打开静脉通道及早用药,提高抢救成功率.现将静脉留置针临床应用过程中的护理体会报道如下.     

Bridging scientist and practitioner perspectives in clinical psychology.

Literature suggests that a complex and often hostile relationship exists between the science and practice of clinical psychology. Contributors to this conflict of viewpoints are reconsidered within the proposition that there are different roads to discovery and that there may be good reasons to keep the science and practice of clinical psychology somewhat separate. Results of a national survey of 325 psychologists are reviewed that support the view that psychological practitioners value research and consider their practices to be augmented by scientific findings. However, they are in need of vehicles of communication that will help them translate scientific findings into practice. Results suggest that practitioners do more to understand scientific findings than scientists do to understand the problems that face clinical practitioners. Ways to facilitate communication between and among these groups are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Questioning the couch: Historical and clinical perspectives.

Since the beginning of the last century, when Freud introduced the couch in the psychoanalytic room, a number of “objects” have been removed or renovated, yet the couch has almost always remained in place, at least officially. This article has two distinct aims. The first is to offer a reconstruction of the psychoanalytic history of this element of the setting. The second is to rethink the couch, saving it from being reduced to a mere icon. Recent contributions coming from affective neurosciences, infant research, and psychotherapy research seem to question the utility of this element and the nature of the very mechanisms of its therapeutic action. The authors wonder whether the use of the couch is primarily protective for the therapist rather than necessarily helpful for all patients. Taking into account these observations implies bringing the couch out from a silent dimension and reflecting on its role in the conception of therapeutic action and mental functioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pharmacokinetics in clinical practice. 2. Applications

The pharmacokinetic concepts introduced and defined in a preceding article are now applied to the management of drug therapy for the individual patient. The factors that affect the time course of drug concentrations in plasma produced by repetitive administration include the dosing rate, total clearance, biologic half-life, and systemic availability of the drug. A clinical pharmacokinetics service can monitor drug concentrations in biologic fluids, design individualized drug-dosing regimens, and carry out pharmacokinetic diagnostic work-ups to help determine the reasons for a patient's unusual response to drug therapy.