Eileen S. O'Neill

The symptom experience of women with chronic illness

The symptom experience of women with chronic illness n nAim of the study:u2002This integrative review examined how women interpret, cope with, and manage chronic illness symptoms. n nBackground:u2002Women with chronic illness report more symptoms and poorer physical health than men. They also enter the health care system later and sicker than their male counterparts. One possible reason for their increased morbidity and mortality is gender differences in interpreting and managing symptoms. n nMethod:u2002The inclusion criteria that guided this review were that: (a) the study was published between January 1, 1990 and December 31, 1999; (b) participants were women with at least one chronic health problem; and (c) the study addressed symptom perception, symptom evaluation, and/or symptom management. Databases were searched using women, symptoms, chronic illness, coping, and research as key words. n nFindings:u2002One hundred and ten published studies were reviewed, yielding 35 journal articles reporting on 32 separate studies that met the inclusion criteria. The analysis identified important gender differences in symptom experience. While studies of coping with symptoms are well represented in the literature, symptom strategies and the cultural meaning of symptoms are understudied. n nConclusions:u2002Five categories of practice implications emerged from the data. These included physical functioning, coping, self-care, roles and relationships, and socio-cultural issues. Within each category specific directions for nursing practice were developed.AIM OF THE STUDYnThis integrative review examined how women interpret, cope with, and manage chronic illness symptoms.nnnBACKGROUNDnWomen with chronic illness report more symptoms and poorer physical health than men. They also enter the health care system later and sicker than their male counterparts. One possible reason for their increased morbidity and mortality is gender differences in interpreting and managing symptoms.nnnMETHODnThe inclusion criteria that guided this review were that: (a) the study was published between January 1, 1990 and December 31, 1999; (b) participants were women with at least one chronic health problem; and (c) the study addressed symptom perception, symptom evaluation, and/or symptom management. Databases were searched using women, symptoms, chronic illness, coping, and research as key words.nnnFINDINGSnOne hundred and ten published studies were reviewed, yielding 35 journal articles reporting on 32 separate studies that met the inclusion criteria. The analysis identified important gender differences in symptom experience. While studies of coping with symptoms are well represented in the literature, symptom strategies and the cultural meaning of symptoms are understudied.nnnCONCLUSIONnFive categories of practice implications emerged from the data. These included physical functioning, coping, self-care, roles and relationships, and socio-cultural issues. Within each category specific directions for nursing practice were developed.

Heuristics reasoning in diagnostic judgment

Heuristics inquiry is an exciting new approach to understanding diagnostic reasoning. Heuristics are short-cut mental strategies that streamline information. Although heuristics allow for faster processing of information than analytic methods, they can lead to errors because not all information is considered. This article describes three heuristics particularly relevant to diagnostic reasoning: accessibility, similarity, and anchoring and adjustment. Specific factors thought to influence heuristic reasoning are reviewed and analyzed. Last, interventions to be tested for both practice and education are presented.

Development of a hand-held real-time decision support aid for critical care nursing

In the current health care environment, nurse clinicians must work faster and smarter making complex decisions on almost a continual basis. Evidence-based knowledge and standardized guides, such as clinical algorithms, can support clinical nursing decisions, however; effective real-time access is limited. This paper outlines research addressing this problem. In this research, current clinical knowledge is delivered to the clinician via an off-the-shelf handheld computer using wireless access to a central server and data repository. Innovative minimal-set database, data mining and knowledge discovery algorithms using a combination of case based and rule based learning with added confidence measures permitting bi-directional (forward and backwards) inferencing based on individual client data are developed and presented for the hand held device. The technology provides real-time decision support for the multiple cases and sequential decisions characterizing present critical care nursing practice. Nurses will be able to consider a full range of alternative explanations, determine additional data needs, find, isolate and examine patient case outliers for additional diagnostic data or verify the appropriateness of a selected strategy. Once fully developed the system will have the capacity to maintain a history of a series of decisions and outcomes thereby over time improving the case base and rule bases used for decision support. Outcomes of the real time decision support aid include more timely health care, less biased decisions, and improved patient outcomes.

The N-CODES project: the first year.

Clinical decision making is a complex task, and particularly challenging for the novice nurse. Little assistance is available, and decision supports such as standardized guidelines are difficult to access in the hectic flow of practice. The Nursing Computer Decision Support (N-CODES) project, directed by investigators for nursing and computer engineering, addresses this problem by developing a prototype of a point-of-care system to deliver clinical knowledge via a handheld computer. This article reports on the progress made during the first year of the project. The nursing investigators have developed a novice-nurse decision-making model, a comprehensive knowledge development process, and a series of computerized practice maps. The focus of engineering has been on designing the database architecture and the knowledge representation, extraction, and discovery algorithms used to mimic nursing knowledge and clinical decision processes in software. But the success of an interdisciplinary collaborative project depends on establishing tasks and boundaries, clarifying persepectives and language, and developing a productive process. Therefore, along with the progress of each discipline, strategies used to promote collaboration are discussed.

Home care nurses' inferences and decisions

The types of inferences and decisions made by home health nurses were explored in this study. One hundred patient care records representing 10 home care nurses primary clients were examined. Two main types of decisions were identified: (1) autonomous with the subcategories of self-directed and consultative and (2) collaborative. Less experienced nurses recorded the most decisions and relied on collaborative decision making more often. Implications include the need for increased autonomy in decision making for home care nurses and the necessity for decision supports for novice nurses.

The N-CODES project moves to user testing.

For a technology to be implemented successfully, it must be thoroughly tested by the stakeholders who will use it in practice. This article reports on the user testing of the Nurse Computer Decision Support working prototype. Ten acute care nurses with varying levels of education and experience participated in the testing. The studys protocol consisted of a series of tasks requiring the participants to use the system while solving patient problems. Both quantitative and qualitative data on usability, ease of navigation, and nurse satisfaction were collected. The nurses ranked usability and ease of navigation highly. Nurses were excited about the systems clinical potential and felt that it would be useful to all practitioners regardless of experience. Testing the system in an actual clinical setting is the next step, but it is clear that the system has extraordinary potential to improve clinical decision making and patient outcomes.

A Computerized Decision Support Aid for Critical Care Novice Nursing

The traditional health care model of a novice nurse interacting with a senior staff nurse in a mentoring role is not possible in todays world of nursing shortages and high patient loads. In addition due to regulatory and legal issues more traceable digitally stored information regarding patient care is require. Collecting this information in real-time may leave less time to the nurse for actual patient care. In a perfect world, the hospital would have all patients records and all information concerning a hospitalization stored and accessible digitally. In reality, due to traditional manual data entry, analysis and recovery inadequacies, the nurse does not have real-time access to such information to aid patient care. Presently most patient data collected is aimed at supporting legal and billing concerns not for assisting with primary patient care. This paper described N-CODES (novice nurses computer decision support system) a research project developing a wireless point-of-care system to assist the acute care novice nurse in making sound clinical judgments.