Impact of continuous vigilance monitoring on nursing workflow.

BACKGROUND: Increasing nursing time in patient care is beneficial in improving patient outcomes, but this is proving increasingly difficult with the nursing shortage, budgetary constraints, and higher patient acuity. OBJECTIVE: Nursing workflow was evaluated after the implementation of a continuous vigilance monitoring system to determine if the system enhanced patient-centric nursing care. METHODS: Work sampling observations were conducted at 3 hospitals for 6 categories of nursing activities (direct and indirect nursing, documentation, administrative, housekeeping, and miscellaneous) at baseline and at 3 and 9 months. RESULTS: Statistically significant increases in direct (3 months) and indirect nursing care (3 and 9 months) were found, with variability between sites. Statistically significant increases at 3 and 9 months for documentation of patient care activities and decreases in administrative activities were the most consistent findings for all sites. CONCLUSION: Continuous vigilance monitoring enhanced patient-centric care with increases in direct and indirect nursing care and documentation of those activities.

Comprehending product warning information: age-related effects and the roles of memory, inferencing, and knowledge.

Two experiments were conducted to determine if age affects comprehension for explicit and implied warning information and, if so, to reveal the nature of such effects. Experiment 1 measured younger (18-23 years) and older (65-75 years) adults' comprehension for real-world warnings via a verification test presented immediately after reading the warnings or after a delay. In Experiment 2, younger (18-22 years) and older (64-76 years) participants also read fabricated warnings that were inconsistent with real-world knowledge. In both experiments, older adults frequently failed to infer the correct hazard and safety information. The older adults also had trouble understanding warning information even when it was explicitly stated (when no inferences were required), especially when memory demands were high and product-specific knowledge could not be used. That many of the older adults did not understand commonly used product warnings indicates that the wording on many household products is not conducive to being understood by everyone who uses them. Actual or potential applications of this research include the recommendation that designers of product labels, warnings, and instructions should consider minimizing memory load and maximizing opportunities for knowledge application when designing consumer warnings.

Safety symbol comprehension: effects of symbol type, familiarity, and age.

A new procedure for evaluating symbol comprehension, the phrase generation procedure, was assessed with 52 younger and 52 older adults. Participants generated as many phrases as came to mind when viewing 40 different safety symbols (hazard alerting, mandatory action, prohibition, and information symbols). Symbol familiarity was also assessed. Comprehension rates for both groups were lower than the 85% level recommended by the American National Standards Institute. Moreover, older participants' comprehension was significantly worse than younger participants', and the older adults also generated significantly fewer phrases. Generally, prohibition symbols were comprehended best and hazard alerting symbols worst. In addition, symbol familiarity was positively correlated with symbol comprehension. These findings indicate that important safety information depicted on signs and household products may be misunderstood if presented in symbolic form. Furthermore, certain types of symbols may be better understood (e.g., prohibition symbols) than other types (e.g., hazard alerting symbols) by both younger and older individuals. These findings signify the utility of the phrase generation procedure as a method for evaluating symbol comprehension, particularly when it is not possible or desirable to provide contextual information. Actual or potential applications of this research include using the phrase generation approach to identify poorly comprehended symbols, including identification of critical confusions that may arise when processing symbolic information.

A medication screening tool for cognitive aging researchers.

A Web-based medication screening tool that provides researchers with information about side effects associated with medications commonly used by older participants is described. This tool can be used for research purposes to better separate the effects of normal, healthy aging processes from the deleterious effects often associated with medication usage. Researchers can use this tool, called SMART (Screening Medications: Aging Research Taxonomy), to (a) obtain information pertaining to the cognitive, sensory, and motor side effects associated with specific medications and (b) screen medications in their research for side effect severity. The Web address for the tool is www.psychology.gatech.edu/SMART

Quantitative Echocardiographic Assessment in Pericardial Disease.

Although echocardiography has been used for diagnosing pericardial effusions since 1965, the grading of such effusions for size, and also the diagnosis of tamponade have depended almost entirely on qualitative observations or "signs." The categorization of pericardial effusions into small, moderate, or large according to the width of pericardial space is very roughly semiquantitative. Diagnostic criteria for tamponade are based on altered ventricular or atrial wall contour, and on phasic respiratory fluctuations of ventricular size and flow velocities. We review a new approach to pericardial effusion volume estimation, based on assessing the pericardial sac volume as well as cardiac volume by the ellipsoid formula. A new quantitative criteria for tamponade (i.e., biatrial width to cardiac width) (annular level) ratio may be useful, a ratio < 0.85 indicating tamponade, reflecting late diastolic biatrial collapse. The echo diagnosis of pericardial constriction depends on pericardial thickening combined with various abnormalities of septal and ventricular wall motion, some of them subtle. We review a new two-dimensional echo "sign" present in some cases of pericardial constriction: abnormal posterior displacement of the left atrial posterior wall, and reduced angle (<150 degrees ) between it and left ventricular wall in long-axis view. Measurements reflecting the fluctuation of certain Doppler parameters can also be useful in diagnosis of this entity.