Illness representations and coping of women with chronic obstructive pulmonary disease: a pilot study.

OBJECTIVE: The purpose of this study was to explore how women recognize and respond to symptoms of chronic obstructive pulmonary disease (COPD). FRAMEWORK: The Common Sense Model by Leventhal provided the theoretic framework for the study. DESIGN: A descriptive qualitative design was used. SAMPLE: The study sample included 21 women enrolled in pulmonary rehabilitation programs. FINDINGS: The causes and consequences of COPD were these women's most prominent representations. They struggled not only with dyspnea and fatigue, but with depression, loss of social support and intimacy, and stigma. Breathing techniques, medication, rest, and avoidance measures were the most frequently used coping strategies. PRACTICE IMPLICATIONS: Because dyspnea is the central symptom, nurses must continue to teach methods to control it, as well as to search for new interventions to relieve the symptoms. Optimal levels of rest and the effect on outcomes deserve close attention. Devising ways to deal with social and psychologic isolation would also enhance coping with COPD.

The N-CODES project moves to user testing.

For a technology to be implemented successfully, it must be thoroughly tested by the stakeholders who will use it in practice. This article reports on the user testing of the Nurse Computer Decision Support working prototype. Ten acute care nurses with varying levels of education and experience participated in the testing. The study's protocol consisted of a series of tasks requiring the participants to use the system while solving patient problems. Both quantitative and qualitative data on usability, ease of navigation, and nurse satisfaction were collected. The nurses ranked usability and ease of navigation highly. Nurses were excited about the system's clinical potential and felt that it would be useful to all practitioners regardless of experience. Testing the system in an actual clinical setting is the next step, but it is clear that the system has extraordinary potential to improve clinical decision making and patient outcomes.

Coupling the N-CODES system with actual nurse decision-making.

Nurses must be involved in the development and testing of clinical decision support systems if systems that fit into the actual clinical decision-making process and the flow of practice are to be designed. This article discusses the first trial of N-CODES, the Nurse Decision Support System. This system is designed to assist nurses, particularly novices, to make clinical decisions. The adequacy of the theoretical framework and selected aspects of the knowledge base were examined. Twelve nurses participated. Results indicated that revision of the theoretical framework is necessary if it is to be a fair representation of nurse's decision-making. The sequencing of information seems appropriate but the process of developing the knowledge base must be made more transparent to nurse users. After modifications, the next trial will test actual clinical use.

The N-CODES project: the first year.

Clinical decision making is a complex task, and particularly challenging for the novice nurse. Little assistance is available, and decision supports such as standardized guidelines are difficult to access in the hectic flow of practice. The Nursing Computer Decision Support (N-CODES) project, directed by investigators for nursing and computer engineering, addresses this problem by developing a prototype of a point-of-care system to deliver clinical knowledge via a handheld computer. This article reports on the progress made during the first year of the project. The nursing investigators have developed a novice-nurse decision-making model, a comprehensive knowledge development process, and a series of computerized practice maps. The focus of engineering has been on designing the database architecture and the knowledge representation, extraction, and discovery algorithms used to mimic nursing knowledge and clinical decision processes in software. But the success of an interdisciplinary collaborative project depends on establishing tasks and boundaries, clarifying perspectives and language, and developing a productive process. Therefore, along with the progress of each discipline, strategies used to promote collaboration are discussed.

Knowledge acquisition, synthesis, and validation: a model for decision support systems.

BACKGROUND: Decision tools such as clinical decision support systems must be built on a solid foundation of nursing knowledge. However, current methods to determine the best evidence do not include a broad range of knowledge sources. As clinical decision support systems will be designed to assist nurses when making critical decisions, methods need to be devised to glean the best possible knowledge. AIMS: This paper presents a comprehensive knowledge development process to develop a nursing clinical decision support system. DISCUSSION: The Nurse Computer Decision Support Project (N-CODES) is developing a prototype for a prospective decision support system. The prototype is being constructed on rules and cases generated by the best available evidence. To accommodate the range of decisions made in practice, different types of evidence are necessary. The process incorporates procedures to uncover, evaluate, and assimilate information to develop the knowledge domain for a clinical decision support systems. Both formal and practice-based knowledge are included. The model contains several innovative approaches including the use of clinical experts and a network of practicing clinicians. CONCLUSION: These strategies will assist scientists and practitioners interested in determining the best evidence to support clinical decision support systems.