Who Do You Think You Are? A Personal Response to Adrienne Harris's "Gender as a Soft Assembly: Tomboys' Stories".

Two decades ago, Adrienne Harris published "Gender as a Soft Assembly," a refreshing, far-reaching paper that intertwines both traditional and cutting-edge psychoanalytic gender theory with anecdotes from Harris's own life as a tomboy in the 1970s. In broadening staid models of development, "Gender as a Soft Assembly" provides the potential for freedom, fluidity, and creativity as an antidote to the rigid, binary constructions of masculinity and femininity. In response, I've summarized the most striking aspects of her paper that coincidentally commingle with my having been a tomboy and offer an opportunity for a reconsideration of my own history.

Modeling Flowsheet Data to Support Secondary Use.

The purpose of this study was to create information models from flowsheet data using a data-driven consensus-based method. Electronic health records contain a large volume of data about patient assessments and interventions captured in flowsheets that measure the same "thing," but the names of these observations often differ, according to who performs documentation or the location of the service (eg, pulse rate in an intensive care, the emergency department, or a surgical unit documented by a nurse or therapist or captured by automated monitoring). Flowsheet data are challenging for secondary use because of the existence of multiple semantically equivalent measures representing the same concepts. Ten information models were created in this study: five related to quality measures (falls, pressure ulcers, venous thromboembolism, genitourinary system including catheter-associated urinary tract infection, and pain management) and five high-volume physiological systems: cardiac, gastrointestinal, musculoskeletal, respiratory, and expanded vital signs/anthropometrics. The value of the information models is that flowsheet data can be extracted and mapped for semantically comparable flowsheet measures from a clinical data repository regardless of the time frame, discipline, or setting in which documentation occurred. The 10 information models simplify the representation of the content in flowsheet data, reducing 1552 source measures to 557 concepts. The amount of representational reduction ranges from 3% for falls to 78% for the respiratory system. The information models provide a foundation for including nursing and interprofessional assessments and interventions in common data models, to support research within and across health systems.

Expanding Interprofessional EHR Data in i2b2.

Emerging issues of team-based care, precision medicine, and big data science underscore the need for health information technology (HIT) tools for integrating complex data in consistent ways to achieve the triple aims of improving patient outcomes, patient experience, and cost reductions. The purpose of this study was to demonstrate the feasibility of creating a hierarchical flowsheet ontology in i2b2 using data-derived information models and determine the underlying informatics and technical issues. This study is the first of its kind to use information models that aggregate team-based care across time, disciplines, and settings into 14 information models that were integrated into i2b2 in a hierarchical model. In the process of successfully creating a hierarchical ontology for flowsheet data in i2b2, we uncovered a variety of informatics and technical issues described in this paper.

Modeling Flowsheet Data for Clinical Research.

Health care data included in clinical data repositories (CDRs) are increasingly used for quality reporting, business analytics and research; however, extended clinical data from interprofessional practice are seldom included. With the increasing emphasis on care coordination across settings, CDRs need to include data from all clinicians and be harmonized to understand the impact of their collaborative efforts on patient safety, effectiveness and efficiency. This study characterizes the extended clinical data derived from EHR flowsheet data that is available in the University of Minnesota's CDR and describes a process for creating an ontology that organizes that data so that it is more useful and accessible to researchers. The process is illustrated using a pressure ulcer ontology and compares ease of finding concepts in i2b2 for different data organization approaches. The challenges of the manual process and difficulties combining similar concepts are discussed.

The experience of community-living men managing fecal incontinence.

PURPOSE: The purpose of this study was to investigate the lived experience of men managing fecal incontinence (FI). METHOD: A phenomenological method was used to investigate the experience of FI. Eleven men participated in unstructured interviews. Van Manen's approach was used for data analysis. RESULTS: The findings display men's experiences of living with FI through space, relationships, time and body. The essential theme generated from the analysis was "secret resignation." Resignation of having FI was the main coping strategy of the men in this study and was reflected in the limited approaches they used to manage their symptoms. The common reason of the resignation was considering FI normal for them and a consequence of aging. DISCUSSION AND CONCLUSION: The findings provide guidance to rehabilitation nurses to first inquire about the presence of FI, education men about its etiologies, and develop plans of care that address men's main concerns.

A family systems nursing intervention model for paediatric health crisis.

AIM: This article discusses the development of a family systems nursing intervention for clinical use in health crisis. BACKGROUND: Although studies in paediatric critical care provide evidence that family stress is an important clinical phenomenon, studies have demonstrated that few nurses have the requisite family intervention skills to provide family members with adequate support during crisis. In addition, few intervention studies that focus on provider-family relationships with the goal of reducing stress have been reported. This article contributes to the literature by redressing this lack. Data sources. The literature search supporting this project spanned from 1980 to 2009 and included searches from classic nursing theory, family theory and relevant nursing research specific to the design of the intervention reported. DISCUSSION: The goal of the intervention is to provide a theoretical and practical foundation for explicit action that enhances relationships with caregivers thereby supporting the integrity of the family and enhancing their coping abilities. The intervention, based on the Family Systems Model and the family's understandings of the situation, defines specific goals and desired outcomes to guide strategic actions. Discussion of the conceptual foundation, procedural development and an example of the protocol is provided. Implications for nursing. The intervention is designed for nurses with limited knowledge in family theory to aid them to better help families dealing with stress. CONCLUSION: The proposed intervention can be used to increase nurses' skills in family centred nursing care. Although designed for use in paediatric critical care, it can, with modifications, be used in other nursing specialty areas.