Simulator effects on cognitive skills and confidence levels.

Use of a human patient simulator (HPS) as a tool for experiential learning provides a mechanism by which students can participate in clinical decision making, practice skills, and observe outcomes from clinical decisions. The purpose of this study was to compare the effectiveness of two instructional methods to teach specific nursing education content, acute myocardial infarction, on junior-level nursing students' cognitive skills and confidence. The instructional methods included an interactive approach using the HPS method, compared with traditional classroom lecture. Results of this study suggest that use of a teaching strategy involving the HPS method made a positive difference in the nursing students' ability to answer questions on a test of cognitive skills. Confidence levels were not found to be significantly enhanced by use of the HPS method.

Presurgical risk factors for late extubation in Medicare recipients after cardiac surgery.

BACKGROUND: Medicare recipients, particularly those 80 years of age and older, are increasingly undergoing coronary artery bypass grafting surgery (CABGS). There is an association between older age and need for prolonged mechanical ventilation (MV); however, it is unclear what other presurgical characteristics may contribute to prolonged time on the ventilator in older adults. OBJECTIVE: To develop and validate a probability model for prolonged MV utilizing selected presurgical patient characteristics. METHOD: A retrospective, nonexperimental design was utilized to study 548 Medicare recipients (65 years of age or older) undergoing CABGS during 1998. Data were obtained from an existing coronary artery surgery clinical database. RESULTS Based on extubation time, the sample was comprised of two groups (Group 1, N = 205; MV 5 hours). Using logistic regression modeling, predictors of late extubation included: (a). age of 80 years or older (odds ratio [OR] 2.99, p =.003), (b). female sex (OR = 1.76, p =.011), (c). hypertension (OR = 1.60, p =.018), (d). urgent or emergent preoperative clinical status (OR = 3.04, p =.002), and (e). prior CABGS (OR = 2.14, p =.009). The predictive model provided moderate discrimination of time to extubation group (concordance statistic = 0.656). CONCLUSIONS: Older age, urgent or emergent preoperative clinical status, and prior CABGS are risk factors for prolonged MV, which have been consistently identified in combined adult and older adult samples. Female sex and hypertension have not been well supported in earlier studies as risk factors for prolonged MV. The exploratory model provides a preliminary indication of factors placing Medicare recipients at risk for late extubation, but requires further development and testing for use by nurses in clinical practice.

Assessing data adequacy for clinical research: reliability and validity of a surgical database.

As clinical databases are utilized more frequently for clinical research, it is essential that researchers assess the quality of databased information. While researchers have begun to report strategies to measure accuracy of databased information, knowledge remains limited. The purpose of this study was to assess the reliability and validity of databased information among selected study variables contained within a computerized coronary artery surgery clinical database using the written patient medical record as an external standard. Both reliability (N = 400) and validity (N = 100) samples were randomly selected from a databased sampling frame of 548 Medicare subjects who underwent coronary artery bypass grafting surgery in 1998. Reliability assessed by consistency rates were age (95%), race (94%), gender (99%), congestive heart failure (CHF) (60.5%), angina (91.5%), renal insufficiency (82%), hypertension (91.7%), diabetes mellitus (93.7%), chronic obstructive pulmonary disease (COPD) (75.5%), clinical status (97%), American Society of Anesthesiologists classification (99%), prior peripheral vascular surgery (15.5%), prior CABGS (99%), and duration of mechanical ventilation (87.5%). These percentages reflected a large portion of missing data for CHF, COPD, and prior peripheral vascular surgery. Validity assessed by sensitivity and specificity analyses were all greater than 80%. The majority of computerized databased information among selected study variables was the same information recorded in the written patient medical record. Using the same external standard to assess both reliability and validity was a significant limitation of this study, which resulted in the same measure of data adequacy by utilizing differing statistical methods.