Digitized images of wounds: a nursing practice innovation.

Although clinical photography is not new, the incorporation of digital wound images into computerized patient records is an innovation recently developed in nursing practice. At the Washington, DC Veterans Affairs Medical Center (Washington DC VAMC), a nurse imaging program is being developed through a unique partnership between a clinical nurse specialist and a nurse informaticist. Digitized images are stored as parts of the ViastA computerized patient record system, making them immediately available throughout the entire medical center, on more than 1500 computers in the clinical environment. Any patient condition that can be represented visually, for example, pressure ulcers, which are the most frequently imaged, can be placed into the medical record. The major benefit of this nurse imaging program is that the status of wound healing can be tracked visually over time, from acute care to the clinic setting, and to the home. Progression from the problem, as originally defined, through the innovation process, and a statement of future plans are presented in the article.

Obtaining "informed" consent from the elderly.

Regardless of the age of the potential subjects, three conditions constitute informed consent: freedom to decide, clear information, and decision-making capacity. Numerous factors associated with the aging process affect elders' abilities to fulfill all of these conditions; however, as research involving the elderly increases, researchers must act responsibly to ensure that the rights and privileges of elderly research subjects are protected. There are numerous techniques researchers can use to increase the likelihood that truly informed consent is being obtained from elderly potential subjects; this article has described a few of these techniques. Many of the techniques mentioned require additional investigator time. Extra time to ensure this is a small price to pay for setting the stage for greater cooperation and increased quality of research. The development and dissemination of informed consent process guidelines geared toward the needs of the elderly would facilitate an individual researcher's efforts to protect elderly subjects.

Preparing for an ICU bedside computer.

Preparing the nursing staff is essential when implementing bedside computers. Realistically, all staff may not be trained before the clinical information system (CIS) goes "live," but resource personnel and the vendor can alleviate stressors associated with the change. Promoting the system early is vital to gain interest and support.

Selection and development of a critical care bedside computer.

A multidisciplinary approach was used to select a bedside computer in a tertiary medical center's medical intensive care unit. Three committees were formed both by the medical center and the vendor: selection, configuration and implementation. A similar committee structure also existed with the vendor. The sets of committees formed a strong partnership to ensure a state-of-the-art system which would be easy to use and provide nursing staff with more time at the patient's bedside.

An interdisciplinary approach to improving the quality of life for nursing home residents.

As people live longer, there is a greater concern about not only the increasing life span but the quality of life (QOL) in later years. The purpose of this project was to design and pilot test interdisciplinary interventions with nursing home residents and to improve their QOL. This article focuses on interdisciplinary interventions that evolved during the project. While this program was an additional responsibility for members of the team, many benefits were realized and range from increased resident satisfaction to cost savings, to the recruitment of staff. An interdisciplinary team approach can be an effective means to improve quality of life for residents of nursing homes.