Computers, informatics, nursing : CIN
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In-hospital mortality rates associated with an ICU stay are high and vary widely among units. This variation may be related to organizational factors such as staffing patterns, ICU structure, and care processes. We aimed to identify organizational factors associated with variation in in-hospital mortality for patients with an ICU stay. ⋯ At the patient level, risk of complications and having a medical diagnosis were significantly associated with a higher risk of mortality. At the unit level, having an interface with the electronic medical record was significantly associated with a lower risk of mortality. The finding that electronic medical records integrated with ICU information systems are associated with lower in-hospital mortality adds support to existing evidence on organizational characteristics associated with in-hospital mortality among ICU patients.
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Smartphones are a new technology similar to PDAs but with expanded functions and greater Internet access. This article explores the potential uses and issues surrounding the use of smartphones in nursing education. While the functions of smartphones, such as sending text messages, viewing videos, and access to the Internet, may seem purely recreational, they can be used within the nursing curriculum to engage students and reinforce learning at any time or location. ⋯ Students can review instructional videos prior to performing skills and readily reach their clinical instructor via text message. Downloadable applications, subscriptions, and reference materials expand the smartphone functions even further. Common concerns about requiring smartphones in nursing education include cost, disease transmission, and equipment interference; however, there are many ways to overcome these barriers and provide students with constant access to current clinical evidence.
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The purpose of this project was to demonstrate how a hospital clinical database can be utilized to calculate individual nursing unit activities that affect nurses' workload. While research has established that staffing is associated with patient safety, few studies have examined ways to measure nurse workload and its impact on patient safety. The widely used midnight census does not account for the number of patients who occupy a bed in a 24-hour period. ⋯ During 1994 to 2006, unit activity index increased. Fluctuations in unit activity index were noted according to shift, day of week, and month. Hospital clinical data repositories can be used to calculate workload measures, and these measures should be incorporated with other traditional measures in making staffing decisions.
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Comparative Study
Comparison of the quality and timeliness of vital signs data using three different data-entry devices.
It is important to evaluate the impact of clinical information systems on the quality and timeliness of documentation in the patient's record to ensure the systems are improving clinical care processes and providing value to the organization. An observational study was conducted to measure the accuracy and timeliness of vital signs data during three different stages of clinical documentation system implementation at a large academic medical center: (1) a paper medical record system, (2) a clinical documentation system with "computers on wheels" workstation outside the patient's room, and (3) a clinical documentation system with a Tablet PC affixed to the vital signs monitor. ⋯ In addition, a number of unintended consequences were discovered that proved helpful to the nurse managers and nursing informatics leadership team in providing support of the new system. Findings from this study emphasize the importance of ensuring that staff has the appropriate devices needed to effectively document patient care at the bedside.
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PAINReportIt, a computerized version of the McGill Pain Questionnaire (Pain. 1975, 1:277-299), presents pain measurement items to responders in serial display screens accompanied by pop-up screens. In this study, we used cognitive interviews to examine further validity of PAINReportIt with 25 African Americans with sickle cell disease. The specific aims were to determine if the questions in the PAINReportIt program were relevant to and understood by African Americans with sickle cell disease and to describe the nature of the pain they experienced. ⋯ The program captured both nociceptive and neuropathic aspects of sickle cell pain and provided detailed information on the location, intensity, quality, and pattern of pain experienced by participants. We recommend that future revisions to the PAINReportIt program address the temporal issues of measuring recurrent pain, resolve technological issues related to pop-ups, and simplify difficult words to better match the typical health literacy levels of patients. These revisions could further enhance the technological aspects, usability, and cultural appropriateness of the tool for African Americans with sickle cell disease.