Comparison of outcome predictions made by physicians, by nurses, and by using the Mortality Prediction Model.

BACKGROUND: Critical care nurses must collaborate with physicians, patients, and patients' families when making decisions about aggressiveness of care. However, few studies address nurses' ability to predict outcomes. OBJECTIVES: To compare predictions of survival outcomes made by nurses, by physicians, and by using the Mortality Prediction Model. METHODS: Predictions of survival and function and attitudes toward aggressiveness of care based on the predictions were recorded on questionnaires in the emergency department by emergency and intensive care unit physicians and by intensive care unit nurses at the time of admission to the unit between February and September 1995 for 235 consecutive adult nontrauma patients. Scores on the Mortality Prediction Model were calculated on admission. Data on 85 of the 235 patients were analyzed by using descriptive, chi 2, and correlational statistics. Nurses' predictions of function were compared with patients' actual outcomes 6 months after admission. RESULTS: Nurses' predictions of survival were comparable to those of emergency physicians and superior to those obtained by using the objective tool. Years of nursing experience had no relationship to attitudes toward aggressiveness of care. Nurses accurately predicted functional outcomes in 52% of the followed-up cases. Intensive care physicians were more accurate than nurses and emergency physicians in predicting survival. All predictions made by clinicians were superior to those obtained by using the model. CONCLUSIONS: Nurses can predict survival outcomes as accurately as physicians do. Greater sensitivity and specificity are necessary before clinical judgment or predictive tools can be considered as screens for determining aggressiveness of care.

Coming of age. Cystic fibrosis--once a childhood disease--makes its way to adulthood.

Cystic fibrosis patients and their caregivers face unusual complexities when these patients move from the pediatric to adult setting.

Evaluating the reliability and utility of cumulative intake and output.

During times of scarce resources available for providing patient care, it becomes necessary to validate the effectiveness of standard practices that consume caregivers' time and efforts. Three nurse managers of nursing units serving diverse patient populations studied the effectiveness of continuous intake and output in estimating daily fluid balance. They examined 48-hour records of daily weight and intake and output of 73 patients and correlated the two. Their findings suggest that even when caregiver charting compliance is optimal, daily intake and output recording provides unreliable results. The authors recommend daily weights alone be adopted for all patients who are not experiencing acute renal conditions.

The reliability of blood sampling from peripheral intravenous infusion lines. Complete blood cell counts, electrolyte panels, and survey panels.

To assess the accuracy of venous blood sampling obtained from peripheral intravenous infusion lines, peripheral saline locks, and by peripheral venipuncture, dual blood samples from 55 hospitalized patients were compared for test reliability. Tests included complete blood cell counts, electrolyte studies, and general survey panels. Results showed that within certain limitations, blood sampling from a wide range of peripheral indwelling devices is reliable for many routine blood tests.

Evolution of compliance within a fall prevention program.

When evaluating the effectiveness of a fall prevention program, it is useful to first determine whether the program is being uniformly administered. Members of a medical-surgical unit's Quality Assurance/Product Improvement Team studied both processes as well as outcomes over a two-year implementation of a fall prevention program. They discovered that initial attempts at implementation underestimated the quantity of resources necessary to ensure full implementation of the program. This article chronicles the series of audits and program modifications that eventually brought about success to this unit.

Nursing wound care survey: sterile and nonsterile glove choice.

PURPOSE: The application of sterile and clean procedure to the practice of wound care nursing was examined. DESIGN: This prospective, descriptive study surveyed staff nurses regarding glove use. SUBJECTS AND SETTING: Seven hundred forty-three staff nurses from five health care agencies in the San Francisco Bay Area responded to the survey. INSTRUMENTS: A self-report wound care survey instrument was developed by Nursing Consortium for Research and Practice members from information adapted from the wound care literature. The questionnaire comprised 31 questions and required approximately 10 minutes to complete. METHODS: Nursing Consortium for Research and Practice members obtained approval from their respective institutional human subjects committees and distributed questionnaires among all nurses engaged in direct care. Some agency representatives personally handed the survey instruments to subjects, but most distributed them through their agencies personnel mailing systems. RESULTS: Seven hundred twenty-three (38%) of 1900 questionnaires were completed and returned to the five site coordinators. Differences were found between acute care and home health nurses. Acute care nurses were more likely than home care nurses to use sterile gloves in all wound care situations. CONCLUSION: Greater variation was found with regard to sterile technique in wound care practice than in previously reported studies. Although patient risk factors and wound type significantly influenced the choice of sterile or clean gloves, additional environmental and personal factors exerted considerable influence. These included health care setting, degree of professional education, and nurses' experiential background. Attempts to modify practice through policy change alone may not be sufficient to overcome resistance to change. Instead, it may be necessary for nurses to "unlearn" lessons from basic nursing education before they can adopt to new practices and clinical policies.

Cost-benefit analysis of an automated medication system.

Automated medication distribution systems have helped solve issues of efficiency and effectiveness. Cost-benefit analysis conducted by nursing and pharmacy departments can help to objectify the decision to adopt this technology.

Tax-deductible education expenses.

Nurse executives facilitate employees' educational development with advice concerning financial assistance programs to help defray educational costs. Nurses also need to know about tax savings that can further ease the burden of expensive continuing education. The following discussion includes a review of tax code provisions for educational deductions, several illustrative tax court cases, and the author's own experience.

The erosion of nursing resources: employee withdrawal behaviors.

A 5-year retrospective cohort study of 404 nurses hired during a 2-year period in five hospitals was conducted in order to explore withdrawal behavior exhibited by 76% of them. Three withdrawal behaviors were examined and compared: turnover, absenteeism, and systematic reduction in participation (reduced work schedules). In two separate regressions, systematic reduction in participation (SRP) and turnover were each regressed on absenteeism, after controlling for six organizational and demographic variables. The relationship between absenteeism and each of the other two behaviors was significant, but opposite in effect. Systematic reduction in participation was found to be an important source of nursing resource loss in some, but not all, hospitals.

Tracking turnover.

A pilot study was conducted testing the utility of a turnover costing and profile analysis system. By applying investment accounting principles, accession costs were graphed as a function of time. Graphs illustrating tenures of leavers were superimposed on cost curves to indicate accounting losses or gains. Optimum limits for work group turnover were determined.