Implementation of a variety of computerized bedside nursing information systems in 17 New Jersey hospitals.

This article examines issues of implementing nursing information computer systems in 17 hospitals in New Jersey and the initial effects of such systems as perceived by users. Unlike previous studies that examined the effects of one system in one hospital, this study examines the effects of several major systems in a variety of settings. Many of the hospitals experienced major delays or other problems with implementation; the hospitals in which timely implementation occurred were the ones that had purchased a commercially available stand-alone nursing system and did not try to develop interfaces or do extensive development. While these hospitals did meet with difficulties and needed some software customization, the problems were not so severe as to impede timely implementation. On the other hand, most of the hospitals that had major delays had planned more ambitious projects. These hospitals either required development work with vendors or were implementing a nursing information system while simultaneously putting in place a hospital system. Initial staff impressions of the effects of the system were positive; nursing department staffs reported that they liked the nursing systems. They said that documentation was better (more readable, complete, and timely) and they also believed that care was improved because the computer prompted nurses on what to look for and what to do. Support for these systems from hospital administration, outside of nursing, was cautious and based primarily on cost/benefit results.

Innovation in nursing: a benefit/cost analysis.

This study found that costs of implementing projects aimed at improving nurse recruitment and retention vary substantially. At 37 hospitals the costs ranged from a mean of $1,029 per bed for shared governance to $8,399 per bed for computer projects. For a typical 30-bed unit implementing a non-computer project, an average of 1,800 hours of personnel time was devoted to implementation. In most cases, hospitals found that the projects took more resources than expected to get off the ground. The benefit/cost results indicate that the potential annual savings in hospital operation costs associated with reduced length of stay were approximately $3,015 for each $1,000 of one-shot implementation costs spent per bed.

Nursing care delivery models and nurse satisfaction.

The relative impact of various nursing care delivery models and management interventions on nurse satisfaction was assessed in 37 New Jersey hospitals. Nurses ranked pay as the most important factor, followed by autonomy and professional status. Changes in scores between pilot and comparison units were significantly different for satisfaction with interactions and task requirements. Change in satisfaction with interaction was significant for all initiatives in aggregate, as well as for each of the five types of initiatives separately. The change in satisfaction with task requirements was significant for all initiatives taken as a group and for those units that implemented reorganization, computer, and education initiatives. Even among nurses who eventually liked the new environment there was a period of initial dissatisfaction.

A comparison of work-sampling and time-and-motion techniques for studies in health services research.

OBJECTIVE: This study compares results and illustrates trade-offs between work-sampling and time-and-motion methodologies. DATA SOURCES: Data are from time-and-motion measurements of a sample of medical residents in two large urban hospitals. STUDY DESIGN: The study contrasts the precision of work-sampling and time-and-motion techniques using data actually collected using the time-and-motion approach. That data set was used to generate a simulated set of work-sampling data points. DATA COLLECTION/EXTRACTION METHODS: Trained observers followed residents during their 24-hour day and recorded the start and end time of each activity performed by the resident. The activities were coded and then grouped into ten major categories. Work-sampling data were derived from the raw time-and-motion data for hourly, half-hourly, and quarter-hourly observations. PRINCIPAL FINDINGS: The actual time spent on different tasks as assessed by the time-and-motion analysis differed from the percent of time projected by work-sampling. The work-sampling results differed by 20 percent or more of the estimated value for eight of the ten activities. As expected, the standard deviation decreases as work-sampling observations become more frequent. CONCLUSIONS: Findings indicate that the work-sampling approach, as commonly employed, may not provide an acceptably precise approximation of the result that would be obtained by time-and-motion observations.

Changing the delivery of nursing care. Implementation issues and qualitative findings.

Faced with a shortage of professional nurses, 37 hospitals in New Jersey implemented a variety of approaches to changing the delivery of nursing care. Implementation issues, including the positive and negative effects of the changes, are discussed. Most project coordinators reported that implementation was more difficult than they had anticipated.

The integrated academic information management system at Columbia-Presbyterian Medical Center.

Over the past seven years, Columbia-Presbyterian Medical Center has been planning and implementing an integrated academic information management system. Accomplishments to date include establishing an institutional information architecture, installing a campus-wide network of workstations, recruiting the staff needed to develop and implement the system, and developing various applications. This paper presents the rationale and steps involved in these accomplishments, as well as data on use of the system so far.

Haematozoa of fishes in Humboldt Bay, California.

Five hundred seven fish representing 45 species from Humboldt Bay, California (USA) were examined for blood parasites. Four fish (less than 1%) from two species were infected. Haemogregarina leptocotti sp. n. is described from one of 33 staghorn sculpin (Leptocottus armatus). Haemogregarina roelofsi sp. n. is described from three of 15 black rockfish (Sebastes melanops). Gametocytes of H. leptocotti sp. n. averaged 6.1 x 2.1 microns with a 2.7 x 1.7 microns oval nucleus; those of H. roelofsi sp. n. averaged 5.5 x 2.7 microns with a 2.5 x 2.2 microns rectangular nucleus. Neither species of parasite had distinct chromatin granules, a polar cap, or more than one gametocyte in an infected cell. Haematozoa are relatively rare in fishes of the northeastern Pacific Ocean.

Computers in oncology nursing: present use and future potential.

Computers assist oncology nurses in their roles as "care integrators" and caregivers. Computers assist nurses in their care integrator role by supporting communication with ancillary departments and by aiding in the collection, organization, and storage of data. Computers helps nurses in their role as caregivers through automated care planning, discharge planning, and patient monitoring and by tracking patients' educational, therapeutic, comfort, or other needs. Using computers, nurses can document their assessments and interventions and patient outcomes while receiving cues and reminders about policies, procedures, and standards of care. In the future, oncology nurses can expect to see computer technology in more hospitals and a host of new developments, such as more intelligent systems, nursing and medical knowledge on-line, documentation at the bedside, and use of patient data bases in education and research.

A controlled trial of adinazolam versus desipramine in geriatric depression.

Thirty outpatients between the ages of 60 and 85 with DSM-III Major Depression entered an 8 week randomized, double-blind comparison of desipramine and adinazolam mesylate, a triazolobenzodiazepine derivative. Outcome was assessed on several measures including the Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Rating Scale, Clinical Global Impressions (CGI), the 35-item Self-Rating Symptom Scale, and Carroll Depression Scale. Patients in both groups demonstrated a highly significant decrease in average HDRS scores (p less than 0.001) over the course of the study. Adinazolam was associated with significantly greater reduction in average HDRS scores by the third day. Repeated measures analysis of variance showed a significantly greater reduction in HDRS scores for adinazolam over the course of the study. The study medications were associated with distinct patterns of adverse reactions. Desipramine more often produced dry mouth, constipation and nervousness, while adinazolam was more likely to cause drowsiness and lightheadedness. Three of these elderly patients, all of whom were taking desipramine reported at least one fall during the study. Adinazolam may be a promising agent in the treatment of depression in the elderly.

How do nurses use their time?

Nurses spend an average of only 31% of their time with patients. The authors determined how nurses spend their time and suggest three ways to reduce time spent on non-essential nursing functions: delegation of some tasks to support personnel, greater use of pharmacy personnel in a decentralized setting, and greater use of computers. Together these changes may both decrease demand for nurses' time and enable professional nurses to focus their energy on tasks that require professional expertise.

Effects of computers on nursing resource use. Do computers save nurses time?

The effects of information systems on nursing resource use are reviewed. The information systems in place in various hospitals differ in major ways; some have an impact on nursing resource use while others do not. Evidence is strong and consistent that computer systems that manage flow of information between nursing units and ancillary departments save time for nurses. The reported findings may even understate the case because workload may have increased during the period of the studies. There is also strong, but unreplicated, evidence that a work plan or electronic Kardex for each patient saves time at report. If nurses are paid for overtime, these savings can translate into cost savings for hospitals. On the other hand, systems that emphasize on-line charting and not communications do not save time. Bedside terminals are too new to have been subjected to careful research by independent investigators, but early reports, which primarily come from vendors, indicate that bedside terminals may further save time and reduce errors. More systematic research into effects of various components is needed to fully document the effect of computers on nurses' time.

Assessment of an interactive microcomputer-videodisc programme for teaching medical students to evaluate the peripheral blood smear.

An interactive microcomputer-videodisc programme for providing instruction in interpreting the peripheral blood smear was evaluated by 23 medical students. The mean scores of the students on a test of interpretation of photomicrographs of blood smears increased significantly after use of the teaching programme. The students' responses to a questionnaire indicated that they viewed computer based instruction as a useful learning tool. The results of the study suggest that computer assisted instruction may be one method for addressing some of the current problems in medical education.

A placebo-controlled inpatient comparison of fluvoxamine maleate and imipramine in major depression.

Fluvoxamine, a selective serotonin reuptake inhibitor, was investigated in a 6-week double-blind study among severely ill inpatients with DSM-III major depression. All but 1 patient also fulfilled criteria for melancholia. Following a 3-day placebo wash-out patients were randomly assigned to fluvoxamine, imipramine or placebo. Sixty of 81 patients completed at least 2 weeks following wash-out and were evaluated for efficacy. Analysis of covariance (controlling for baseline scores) showed significant (p less than 0.05) differences on CGI severity and BPRS total and a similar trend (p = 0.08) on the Hamilton Depression Scale. Fluvoxamine was superior (p less than or equal to 0.02) to both placebo and imipramine on these measures. Fluvoxamine's most common adverse effects were nausea and agitation. The number of fluvoxamine patients withdrawn for side-effects was less than imipramine and not significantly different than placebo. Fluvoxamine was not associated with significant changes in vital signs, ECG or laboratory tests. The results therefore indicate that fluvoxamine is a safe and highly effective treatment for hospitalized patients with major depression.

A double-blind comparison of fluoxetine, imipramine and placebo in outpatients with major depression.

Fluoxetine is the first selective serotonin reuptake inhibitor antidepressant to be marketed in the U.S. In this double-blind trial fluoxetine was compared with imipramine and placebo among 198 outpatients with DSM-III major depression, of whom 145 completed at least 2 weeks of active treatment and were evaluated for efficacy. Significantly fewer patients in each active drug group terminated early due to lack of efficacy compared to placebo. Both imipramine and fluoxetine were significantly superior to placebo on most measures. There were no consistently significant differences between the two active drugs although a trend favored imipramine on a number of measures. Fluoxetine was generally well tolerated. Significantly more imipramine than placebo patients terminated early due to side-effects while the fluoxetine-placebo difference was not significant. The results support previous studies which suggest fluoxetine's superior side-effect profile and the approximate antidepressant equivalence of fluoxetine and TCAs.

IAIMS at Columbia: a strategic plan and model project.

This report describes the Integrated Academic Information Management System (IAIMS) prototype project at the Columbia-Presbyterian Medical Center, the factors that led to the selection of this particular project, and the planning for its implementation. The lessons learned to date and implications for the library are summarized.