Prevalence and types of wounds among children receiving care in the home.

The purpose of this study was to determine the number of children with wounds receiving home care, determine the types of wounds among these children, and identify wound care products used in the treatment of children. This study was a multi-site, descriptive, cross-sectional, collaborative, study involving 13 home healthcare agencies and a university. Nurses (n = 281) were systematically selected to collect data for patients receiving home care visits during a 1-week period. The nurses recorded data on 77 children who ranged in age from less than 1 year to 18 years (mean = 3.1 years, SD = 4.72). The children included 47 males and 30 females, most of whom were African-American (n = 59). Among the 77 children, 16.9% had wounds. Children with wounds were significantly older and had more reasons for the home healthcare visit than children without wounds. The presence of a wound was not significantly related to the length of the visit, gender, or race. The most common wound was a surgical incision. The wound care treatments used most were tap water and gauze. In conclusion, wound care is frequently part of the care for a child in the home. Therefore, nurses need to be aware of wound assessment and wound care protocols that match a child's growth and development and family needs.

Wound prevalence, types, and treatments in home care.

OBJECTIVE: To ascertain the number of home care patients with wounds, determine the types of wounds being treated in the community, and identify wound care treatments used at home. DESIGN: Descriptive, multisite, collaborative project. SETTING: 13 home care agencies located throughout lower Michigan that had voluntarily formed a research consortium. The location of patients visited was 43% urban, 39% suburban, 16% rural, and 2% unaccounted. PATIENTS: Systematic sampling was used to select nurses in each agency to collect data. Nurses (n = 281) recorded information about adult patients visited during the 1 week of the study. Data were recorded about 2847 patients, M age = 72.5 years. They included 1793 women and 1040 men (gender was not recorded for 14 patients); most patients in the sample (72%) were white. MAIN PLANNED OUTCOMES: A significant number of home visits would include wound care and that wound care would be primarily done with tap water and gauze. RESULTS: Wounds were present in 36.3% of patients. Of the patients with wounds, 58.3% had 1 wound and 41.7% had multiple wounds. Wound types included surgical (62.4%), pressure ulcers (24.9%), and vascular leg ulcers (22.2%). Tap water and gauze were the most-used wound care treatments. Patients with wounds had significantly longer home care visits than patients without wounds. CONCLUSIONS: Patients with wounds are commonly found in home care. There is a low utilization of specialty dressings and commercial irrigation solutions across all wound types. Nurses who follow patients with wounds may need additional time to provide the care.

Cost considerations in patient-controlled analgesia.

Patient-controlled analgesia (PCA) is the use of a portable infusion pump activated by the patient to inject an analgesic drug intravenously, subcutaneously or epidurally. PCA permits a patient to deliver a small bolus of opioid to achieve prompt relief without over sedation. Use of PCA for pain management is increasing in hospitals and home settings, largely because it can provide equivalent or better analgesia than conventional methods, and patients are more satisfied with its use. This article reports on studies published between January 1984 and December 1995 which considered cost aspects of PCA. Most studies compared the direct costs of administering PCA with the cost of other forms of drug delivery, usually intramuscular injections. A few studies have included indirect costs such as length of stay and adverse effects associated with the use of PCA. The research on cost considerations of PCA is dominated by case reports, descriptive studies and poorly designed quasi-experimental studies. The most complete and well conducted studies usually have included only drug, equipment and labour costs. Only 6 randomised controlled trials were reported, all of which were conducted on postoperative patients. The cost effectiveness of PCA for pain management is an unresolved question because of the variability in methods used to determine costs and expenses, the different settings and patient populations in which PCA is applied, the different means to organise its management and the fact that it is a rapidly evolving technology during an era of changing reimbursement practices. There is substantial variation in the cost of drugs used in PCA and in the devices themselves, which influences the comparison of costs across studies. Also, researchers do not include the full scope of costs associated with the use of PCA in comparison with conventional drug delivery methods and some do not measure the level of pain relief achieved. Of the few complete and well designed published studies found, PCA was reported to produce superior analgesia at a higher cost than conventional intramuscular therapy in 3 studies, but to be more costly and produce less pain relief than intramuscular therapy in 1 study. There is a pressing need for cost-effectiveness, cost-utility and cost-benefit analyses to determine the appropriate clinical and cost circumstances for the use of PCA.

Patient satisfaction with nursing care in hospitals.

Patient satisfaction has become one measure of quality of nursing care. This article reports on two preliminary studies and one major study of the Patient Satisfaction with Nursing Care Questionnaire. This questionnaire includes four general questions related to the patient's satisfaction with the overall stay in the hospital, food provided, and medical and nursing care received and 15 items that measure satisfaction with three dimensions of nursing care: caring about patients (interpersonal), technical skills, and patient education.

Toward standard classification schemes for nursing language: recommendations of the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice.

The American Nurses Association (ANA) Cabinet on Nursing Practice mandated the formation of the Steering Committee on Databases to Support Clinical Nursing Practice. The Committee has established the process and the criteria by which to review and recommend nursing classification schemes based on the ANA Nursing Process Standards and elements contained in the Nursing Minimum Data Set (NMDS) for inclusion of nursing data elements in national databases. Four classification schemes have been recognized by the Committee for use in national databases. These classification schemes have been forwarded to the National Library of Medicine (NLM) for inclusion in the Unified Medical Language System (UMLS) and to the International Council of Nurses for the development of a proposed International Classification of Nursing Practice.

Cancer pain guidelines: now that we have them, what do we do?

Addressing the what, who, when, where, and how of implementing the AHCPR guidelines is an attempt to simplify what may be an overwhelming process. Use the suggestions presented in Figure 1 to formulate an action plan, and remember to assign a time frame and individual accountability. The commitment to moving the guidelines from the bookshelf to the bedside begins now. Using a process such as this will assist efforts to improve care of patients in pain. It is our hope that a year from now the copy of the AHCPR cancer pain guidelines on your shelf will not be covered with dust but rather will be a well-worn text translated to practice.

Using large data bases in nursing and health policy research.

Concern about the quality, cost, and outcomes of health care has become a driving force in health policy research. The growing accessibility of large clinical and administrative health care data bases has led to an interest in using such data in health policy research. Clinical data bases are created by providers of care and contain data about episodes and outcomes of care, usually organized as patient records. Administrative data bases contain data about indirect care processes such as insurance claims processing, vital event recording, and quality assurance. Clinical and administrative data bases may contain millions of records, consist of data from multiple sites, and often have missing data issues that must be considered by researchers. These and other characteristics of large data bases require special data manipulation and analytic techniques. Large data bases have been used in epidemiological studies, risk assessment, and technology assessment and to study variations in caregiver practice patterns. Because the use of large data bases by nurse researchers has been constrained by the lack of nursing-relevant data in them, there is a need to reach consensus on useful and feasible nursing data elements and to include those data in ongoing data collection efforts by government agencies and private organizations.

Developing clinical practice guidelines: an interview with Ada Jacox. Interview by Barbara Bednar.

In 1992, the Agency for Health Care Policy and Research (AHCPR) released the first in a series of clinical practice guidelines designed to assist hospitals, practitioners, insurers, and consumers in learning more about which medical practices work and how that knowledge should be applied to delivering health care. In this interview, Ada Jacox, PhD, RN, co-chair of the pain management panel, discusses the development of clinical practice guidelines, their importance to health care professionals and consumers, and their possible impact on future practice.

Evaluating the appropriateness of a nurse expert system's patient assessment.

The Urological Nursing Information System (UNIS) is an expert-system prototype designed to help nurses perform patient assessments on elderly nursing home residents known to be incontinent of urine. A study was conducted to evaluate the appropriateness of the patient-assessment parameters stored in the knowledge base of UNIS. These parameters were stored as objects--a kind of template for holding related clusters of data, facts, rules, hypotheses, or any knowledge in a single conceptual unit. Each object was rated for its appropriateness by 14 nurse experts. Resulting scores ranged from +14 to -14. The effect of the nurse experts' educational backgrounds and work settings on their ratings were also analyzed. The results indicated that 95.6% of the objects received favorable ratings from the nurse experts. Educational background was not a significant factor chi 2 = 5.2, but work settings did have a significant affect chi 2 = 21.07, p = 0.01.

An interview with Daniel Carr and Ada Jacox. Interview by Carmella A. Bocchino.

When clinicians are aware of inappropriate variations in practice and have access to science-based recommendations for care, they usually change their practice styles and prescribing behavior. The first in a series of guidelines supported by the Agency for Health Care Policy and Research, "Acute Pain Management," was released in early March and recommended an aggressive, proactive, and collaborative approach to managing pain in patients recovering from surgery, medical procedures, or trauma cases. Co-chairs of the pain management panel, Drs. Daniel Carr and Ada Jacox, share their views on guideline design, the expert panel, consensus building, and their expectations for use by the clinical practice and research communities.