Cooperation and collaboration for clinical nursing research. The Akron-Canton Clinical Nursing Research Network.

Nursing research suffers from an image of being an academic exercise even though it is essential for the growth and improvement of professional practice. With the current emphasis on redesign and cost containment, nurses need to come to the planning table with information and data to assist in decision making and to keep the nursing perspective in patient care. There are barriers to conducting nursing research, but a group approach, through a regional clinical nursing research network, provides the support and resources for an active research program.

Intra-aortic balloon pump complications: A five-year retrospective study of 283 patients.

OBJECTIVE: To determine the type, incidence, and risk factors for complication with the intra-aortic balloon pump. DESIGN: Descriptive, chart review. SETTING: Midwestern community teaching hospital. PATIENTS: Two hundred eighty-three patients with 287 intra-aortic balloon pump insertions from January 1, 1990, to December 31, 1994. OUTCOME MEASURES: Complications of therapy. RESULTS: Seventeen percent of balloon insertions resulted in minor complications, and 14 patients had major complications. Polychotomous logistic regression was used to determine which study risk factors were predictive of the development of minor or major complications in patients. Patients with longer balloon duration had an increased risk of a major complication; whereas smokers and patients with lower body mass index had an increased probability of the development of a minor complication.

Assessing the impact of reengineering on nursing.

OBJECTIVES: This study assessed the impact of organizational re-engineering on nursing in a large community teaching hospital in the Midwest, using an observational repeated measures design. Time, clinical unit, and nurse characteristics were incorporated as covariates. A second objective was to compare two sampling approaches for robustness and efficiency. BACKGROUND: Economic and technological changes are having an enormous impact on acute care hospitals, which often attempt to adapt by re-engineering or restructuring their systems. Despite the difficulty of conducting research in a constantly changing setting, it is imperative that nursing evaluate its reactions and contributions to new delivery models. METHODS AND SUBJECTS: During a hospital-wide reorganization, mail surveys were conducted to assess nurses' perceptions of their authority and autonomy in a new nursing model, commitment to a new philosophy (patient-focused care), and satisfaction with their ability to deliver care. To validate the findings, patient satisfaction was evaluated through a survey of 227 hospitalized patients. Over a 1-year period, two sampling approaches were used: three independent samples of nurses were surveyed at three dates, and a panel of nurses were surveyed repeatedly over the same three dates. Response rates were approximately 45% across the independent samples and 67% for the panel. RESULTS: Comparison of nursing units that underwent re-engineering and units in which re-engineering was delayed showed no obvious effects. Data also showed that the estimates of effects of re-engineering were not subject to confounding from nursing unit, date, or nurses' experience, although there was evidence that the measures were sensitive to these covariates. No biases were found due to the two sampling schemes, yet the panel data was three to five times more efficient--that is, they produced more information--than the data from the independent samples. CONCLUSIONS: This study reinforces the need to build evaluation research into organizational activities such as re-engineering. It also argues for the commitment of resources to organizational research so that information valuable to nursing and the healthcare system is not lost.

Orphan products: drugs and devices for rare diseases.

The issues of orphan products include an inadequate definition of orphan status that hampers implementation of the legislation, difficulties in evaluating the products themselves in order to ensure safety and effectiveness, neglect in developing orphan devices, and conflict over creating unnecessary monopolies and excessive profits. However, it has been demonstrated that the ODA is effective in stimulating the development of these much needed drugs and devices. The next efforts therefore can be directed toward increasing the effectiveness and ensuring the equity of the program.

Technology anxiety as a potential mediating factor in response to medical technology.

Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N = 414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.

The appropriate use of high-cost, high-risk technologies: the case of total parenteral nutrition.

An assessment of total parenteral nutrition (TPN), a high-cost, high-risk technology, is used to illustrate the importance of technology assessment to quality assessment. A review of the literature suggests that TPN is only sometimes effective and that it actually produces measurable harm by increasing complication rates in certain groups of patients. However, there are strong advocates for its use. The economic and ethical implications of TPN for the quality of care are also discussed at the levels both of the individual and of society. Continuous assessment of health care technologies, particularly those that are high-cost and high-risk, is critical to the overall quality of health care.

A classification of nursing technology.

In the previous issue, the authors described the process of technology assessment and its implications for nursing. In this article, the authors propose a classification system for nursing technology. They argue that, in the face of competition from other, rapidly proliferating health care professions, such a system is necessary to insure that nurses are acknowledged and adequately compensated for the functions they actually perform.

Technology, its assessment, and nursing.

Technology assessment provides nurses with the knowledge they need to participate in decisions about the use of health care technology.