Mary Etta Mills

Two-stage evaluation of the impact of a nursing information system in Taiwan

PURPOSE This study evaluated the post-implementation impact of a nursing information system and identified issues related to the technology adoption process. Given the high level of investment necessary to implement information systems, evaluation has become vital to ensure successful adoption and use. Improved understanding of implementation difficulties/barriers and factors leading to them can serve as a platform for the development of strategies and education programs for users. METHOD The study design was a two-stage data comparison analysis of a nursing information system focusing on computerized nursing care plan use. Data were collected from nurses by questionnaire during the first month (December 2004) and 1 year after system installation (December 2005). RESULTS While nurses gave the information technology a higher evaluation score at the second stage than at the early stage, the overall ratings were slightly negative at both stages. Age and pressure to use the system were critical factors at both stages, whereas computer skills and perceived time using the system were vital at the beginning stage of implementation. Issues of concern at both stages were system functionality, efficiency, usability, and user support. CONCLUSION Implementation of an information system requires consideration of issues involving hardware and software, staff training, organizational policy, and workflow changes.

Is there a relationship between service integration and differentiation and patient outcomes

Abstract Objective To examine the level of service integration within Maryland hospitals and service differentiation across the hospital system or network and its affect on heart failure patient clinical and economic outcomes. Data sources/Study setting Maryland Health Services Cost Review Commission Inpatient Data for 1997 and 1998 were used for secondary data analysis. Study design Retrospective cross sectional. Independent variables were the level of service integration and differentiation created from the 1998 American Hospital Association Annual Survey based on the work of Bazzoli et al. [1]. The primary dependent variables were readmission, in-hospital mortality, length of stay and costs. Data collection/Extraction methods Patients discharged from Maryland hospitals with a diagnosis that grouped to DRG 127 (heart failure) were extracted. Multivariate linear and logistic models clustered by hospital were used to analyse results at the patient level. Principal findings A higher likelihood of readmission was found as the level of Community Differentiation increased. Although costs were higher as Total Differentiation increased in 1998, these results were not validated by 1997 data. No significant relationship was found between integration of services and outcomes. Conclusions Similar outcomes were achieved regardless of the level of service integration or differentiation. Community hospitals produce similar patient outcomes at the same cost for this diagnosis.

Application of data mining to the identification of critical factors in patient falls using a web-based reporting system

PURPOSE The implementation of an information system has become a trend in healthcare institutions. How to identify variables related to patient safety among accumulated data has been viewed as a main issue. The purpose of this study was to identify critical factors related to patient falls through the application of data mining to available data through a hospital information system. METHOD Data on a total of 725 patient falls were obtained from a web-based nursing incident reporting system at a medical center in Taiwan. In the process of data mining, feature selection was applied as the first step, after which 10 critical factors were selected to predict the dependent variables (injury versus non-injury). An artificial neural network (ANN) analysis was applied to develop a predictive model and a multivariate stepwise logistic regression was performed for comparison purposes. RESULTS The ANN model produced the following results: a Receiver-Operating-Character (ROC) curve indicated 77% accuracy, the positive predictive value (PPV) was 68%, and the negative predictive value (NPV) was 72%; while the multivariate stepwise logistic regression only identified 3 variables (fall assessment, anti-psychosis medication and diuretics) as significant predictors with ROC curve of 42%, PPV of 26.24%, and NPV of 87.12%. CONCLUSION In addition to medication use such as anti-psychotic and diuretics, nursing intervention where a fall assessment is conducted could represent a critical factor related to outcomes of fall incidence.

The Effects Of Human Contact On Cardiac Arrhythmia In Coronary Care Patients

It is part of common wisdom that interactions between a doctor or a nurse and a patient can modify patientss cardiac activity. However, the ubiquity of that knowledge has tended to obscure recognition of the fact that the magnitude, generality, and mechanisms of the cardiovascular effects of human contact are poorly understood. To explore the effects of human contact on the heart activity, coronary care patients were studied by noting on a continuous electrocardiogram each time any person came in contact with the patient. Results of these studies have shown that human contact, can have major effects on cardiac function of coronary care patients. These effects include phenomena such as heart rate changes of over 30 beats/minute, a doubling of the frequency of abnormal heart beats, and major changes in the conduction of electrical impulses in the heart and may take place with such routine clinical interactions as pulse taking and comforting behavior. Similar responses to human contact observed in patients on a shock-trauma unit who were paralyzed with d-tubocurarine suggest that such responses are central in origin, are not dependent on changes in respiration or movement, and can occur in subjects without pre-existing cardiac pathology. Moreover a number of studies over the past decade have shown that human contact can have major effects on the cardiovascular functioning of healthy animals, including dogs and horses These results indicate the need for quantification of the phyciological effects of many kinds of clinical interactions and the necessity for specification of ongoing human interactions accompanying epidemiological studies of the frequency of arrhythmia in coronary patients of the effects of antiarrhythmic drugs on that frequency. Although the extent and responsible mechanisms for such effects are not yet fully known, additional studies are currently underway aimed at uncovering such knowledge.

Technology acceptance and quality of life of the elderly in a telecare program.

As information and communication technology applied to telecare has become a trend in elder care services, evaluation of the program is vital for further program design and development. This study evaluated the variables influencing the use of a telecare service program by the elderly. A questionnaire survey was used to explore the relationship between quality of life and technology acceptance of a telecare program in Taiwan. In addition, open-ended questions were used to elicit qualitative information regarding the experience of technology use. The results revealed that elderly persons with better social welfare status and health condition, who used the device frequently, had higher quality of life and accepted technology use. The correlation results also indicated that elderly persons who perceived telecare as useful in solving health problems, had the intention to use the program, and were willing to continue use, also had a better perception toward quality of life regarding their interpersonal relationships and living environment. Nonetheless, cost may be an issue that will impede their willingness to use the technology in care service.

Analysis of patient profile in predicting home care resource utilization and outcomes.

OBJECTIVES The study identifies patient profile variables that explain variation in resource utilization and outcomes for home healthcare. BACKGROUND The healthcare reform and the demand for quality patient care have increased the need to identify key patient characteristics that can predict the use of resources and outcomes; however, home healthcare industry currently lacks adequate information collection to reflect these needs. This study explored both the resource use and care outcomes for nursing administrators in monitoring quality, resource distribution, and reimbursement policy decision making. METHOD The conceptual framework is based on Donabedians quality care elements (structure, process, and outcome) and Nursing Minimum Data Set. This is a retrospective descriptive study design in which 244 patient records and data were obtained from a home healthcare agency located in Washington, DC. A series of stepwise and discriminant analyses was conducted for data analysis. RESULTS The findings indicated that the total number of nursing diagnoses and two specific nursing diagnoses (alteration in mobility and knowledge deficit in i.v. therapy) were strong predictors of overall resource use. Prognosis proved to be the strongest predictor of discharge outcomes. CONCLUSIONS/IMPLICATIONS The results indicated that data related to nursing diagnoses and nursing interventions can provide valuable information in predicting resource use. Prognosis made by nursing judgment was also sensitive in predicting patient outcomes. These critical data elements should be included in describing home health patient characteristics and related resource utilization and care outcomes.

Effects of human contact on the heart activity of curarized patients in a shock-trauma unit☆

Abstract This study examines the effects of human contact on the heart rate of four seriously injured patients who were on d-tubocurarine and artificially respirated. All four patients showed significant heart rate changes during routine clinical interactions such as pulse taking or when a nurse held their hand and comforted them. Coupled with previous animal and human observations, these findings indicate that human contact can serve as a potent stimulus for change in cardiovascular functioning of other humans. These studies also indicate that heart reactions to human contact (1) occur in patients where musculoskeletal movements are blocked and who are respired regularly, (2) occur even in the context of intense sensory bombardment, (3) can be of a magnitude equivalent to such strong physical stimuli as tracheal suction, and (4) can occur even when the patients are described as unconscious and comatose.

Association between ozone and emergency department visits: an ecological study

The objective of this study was to examine the association between the levels of ozone concentration and emergency department (ED) visits for respiratory and cardiovascular conditions in Maryland in the United States by considering temporal and spatial characteristics, including socioeconomic status (SES), as a covariate. This study used multiple large datasets derived from government agencies for data of ozone, weather, census, and ED visits to represent Maryland in the summer of 2002. Block kriging was used to estimate the daily ozone and weather factors by ZIP code-day level. Results from a negative binomial regression showed that a 10-ppb increment of the 8-hr ozone level as a three-day average was associated with increased respiratory ED visits by 2.4%, after adjusting for weather factors, SES, and day of the week. For cardiovascular ED visits, an increment of 10 ppb of the 8-hr ozone level as a five-day average increased by 3.5%.

Technology anxiety as a potential mediating factor in response to medical technology

Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N=414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.

Effect of pulse palpation on cardiac arrhythmia in coronary care patients.

In a study of 62 coronary care patients, 31 of whom exhibited types of cardiac arrhythmia, the frequency of ectopic beats changed significantly when a nurse palpated the pulse. This finding suggests that autonomic responses to human contact can significantly alter the rate of ectopic impulse generation. These findings further suggest that studies of cardiac arrhythmia should attend to the nature of the social field in which data are collected.