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System Use (system + use)
Selected AbstractsWhy patients attend emergency departments for conditions potentially appropriate for primary care: Reasons given by patients and clinicians differEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Malcolm Masso Abstract Objectives: To compare reasons identified by clinical staff for potential primary care attendances to the ED with those previously identified by patients. Methods: Survey of staff and primary care patients in five ED in New South Wales, Australia using questionnaire based on reasons identified in published studies. Results: Clinicians in the survey identify a broader spectrum of reasons for potential primary care cases presenting to the ED than the patients themselves report. Doctors reported on average 4.1 very important reasons and nurses 4.8 compared with patients 2.4 very important reasons. The main reasons identified by both doctors and nurses were similar and quite different to those identified by patients. Clinicians were more likely to emphasize cost and access issues rather than acuity and complexity issues. There was no difference within the clinician group between doctors and nurses nor by varying levels of experience. Furthermore doctors with significant experience in both primary care and emergency medicine did not differ from the overall clinicians' pattern. Conclusions: These data confirm that clinician perspectives on reasons for potential primary care patients' use of ED differ quite markedly from the perspectives of patients themselves. Those differences do not necessarily represent a punitive or blaming philosophy but will stem from the very different paradigms from which the two protagonists approach the interactions, reflecting the standard tension in a provider , consumer relationship. If policy is to be developed to improve system use and access, it must take both perspectives into account with respect to redesign, expectations and education. [source] Management of complicated head and neck wounds with vacuum-assisted closure systemHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2006Brian T. Andrews MD Abstract Background The vacuum-assisted closure system (V.A.C.), or negative pressure dressings, has been successfully used to manage complex wounds of the torso and extremities, but its role in the head and neck region has not been frequently described. Methods A retrospective study was performed. The V.A.C. system (Kinetic Concepts Inc., San Antonio, TX) was used at the University of Iowa Hospitals and Clinics for management of complicated head and neck wounds. Results The V.A.C. system was utilized at 13 sites for 12 patients. Nine subjects had exposed calvarium (4 had failed pedicled reconstructive flaps, 3 had ablative or Moh's defects, and 2 had traumatic scalping injuries) necessitating bony coverage. Three subjects had the V.A.C. system used as a bolster dressing placed over split-thickness skin grafts (STSGs) used to reconstruct large defects of the face and skull, and 1 patient had a large soft tissue neck defect after radical surgical resection for necrotizing fascitis. One subject used the V.A.C. system for the management of 2 distinct wounds. All patients had successful healing of their wounds with the V.A.C. system without complication. All STSGs had 100% viability after 5 to 7 days of the V.A.C. system use as a bolster dressing. Conclusion This study demonstrates the V.A.C. system is a valuable tool in the management of complicated head and neck wounds. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] An examination of the use of high-investment human resource systems for core and support employeesHUMAN RESOURCE MANAGEMENT, Issue 2 2007David P. Lepak In this study, we examine two competing perspectives regarding the relative use of high-investment human resource (HIHR) systems for core and support employees within establishments. Using data from 420 establishments, we compare a universal perspective suggesting that the level of HIHR exposure core employees receive is always greater than the level of exposure for sup-port employees, with a contingency perspective suggesting that the relative level of exposure for these employee groups is contingent on strategy, HR philosophy, or industry. The results did not provide support for the universal prediction that core employees always receive higher levels of exposure to HIHR systems than support employees within the same establishment. Moreover, while strategy and HR philosophy were positively related to the level of HIHR system use across establishments, they did not influence the relative level of exposure to HIHR systems for core and support employees. Interestingly, however, industry did exert a unique impact such that core em-ployees received significantly greater exposure to HIHR systems than sup-port employees in nonmanufacturing firms. There were no significant differ-ences in exposure for these two groups in manufacturing industries. Implications of the findings are discussed. © 2007 Wiley Periodicals, Inc. [source] An Internet-Based Survey of Icelandic Nurses on Their Use of and Attitudes Toward NANDA, NIC, and NOCINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Gyda Bjornsdottir PURPOSE To gain understanding of how Icelandic nurses can be supported during a mandated change to the use of NANDA and NIC in clinical documentation practices. METHODS All members of the Icelandic Nurses Association of working age were invited to participate in an Internet-based survey. Each nurse was assigned a unique password mailed to his/her home along with information on how to access the survey Web site. Each nurse could submit answers only once. On submission, data were automatically coded and saved in a database under encrypted numerical identifiers. FINDINGS A total of 463 nurses (18% response rate) participated by submitting answers. The sample was representative of the population in terms of demographic characteristics. Information resources most valued when planning nursing care included text-based progress notes (77%), nursing care plans (52%), doctor's orders (49%), verbal information (48%), and documented nursing diagnoses (37%). Of the participants, 58% said NANDA was used in their workplace; 28% said no standardized nursing documentation was used; 19% reported using NIC always or sometimes when documenting nursing interventions; and 20% never used NIC. NOC use was reported only by researchers. Of the sample, 86% reported that it is important or necessary for nurses to standardize documentation practices; 30% found NANDA useful in education; 56% found it useful for clinical work; 17% for research; and 7% found it not useful at all. Nine percent believed that NANDA diagnoses were not descriptive enough of patients' problems, and 23% found their wording problematic. No statistically significant differences were found between reported use of or attitudes toward NANDA and NIC when comparing nurses who use electronic patient record systems that support NANDA and NIC documentation and those who use paper documentation only. DISCUSSION The sample may have been somewhat biased toward computer use and classification system use for standardized and computerized documentation. However, results indicate that although Icelandic nurses give free-text progress notes and verbal information a higher priority than nursing diagnoses as an information resource for care planning, they have a positive attitude toward NANDA. NANDA and NIC are still used inconsistently in clinical practice, and 28% of participants claimed not to use any form of standardized documentation. CONCLUSIONS In an effort to standardize clinical documentation among nurses, Icelandic health authorities must follow their documentation mandates with educational and technologic support to facilitate the use of NANDA, NIC, and (after its translation) NOC in nursing documentation practices. Electronic patient record system developers must find ways to further facilitate standardized nursing documentation because currently there seems to be no difference between users and nonusers in terms of how they use NANDA and NIC in their documentation practices. [source] Holiday users of the Internet , ease of use, functionality and noveltyINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 4 2008Chris Ryan Abstract This study is based upon a sample of 517 international visitors to New Zealand. It suggests that Internet usage is based upon perceived usefulness and ease of system use. Of additional importance is user confidence about system security. Functional issues of purchasing seem to take priority over information search as users become more familiar with web pages. An additional finding is that entertainment needs are arguably better met by other Internet functions than those provided by destination web pages. Novelty on the Net is perhaps sought from specific sources, and not from the Net generally. Implications are discussed for both measurement and marketing. Copyright © 2008 John Wiley & Sons, Ltd. [source] Employees' choices in learning how to use information and communication technology systems at work: strategies and approachesINTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 1 2010Eija Korpelainen The purpose of this paper is to promote the understanding of how employees learn to use information and communication technology (ICT) systems at work. The elements of a learning activity in the context of ICT use are identified from the literature. In particular, approaches to learning, learning strategies and problem-solving strategies are reviewed. The empirical part of the study examines how employees choose to start learning how to use ICT systems, and how they choose to learn while solving problems related to system use. The data were collected using qualitative semi-structured interviews with 39 employees in three organizations. The interviewees usually preferred to learn how to use ICT quickly and without investing too much effort. The interviewees preferred informal learning and problem-solving strategies. The most commonly used strategies were to try things out alone or together with peers, or to ask for help from peers. The main conclusions of the study are that the users' learning intentions affect the kind of learning support they need and that ICT learning is best approached as a learning activity strongly rooted in collaboration and the social context. [source] Use of Medicare and Department of Veterans Affairs Health Care by Veterans with Dementia: A Longitudinal AnalysisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Carolyn W. Zhu PhD The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA),only use, dual VA and Medicare use, and Medicare-only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998,2001) for 2,137 male veterans who, in 1997, used some VA services, had a formal diagnosis of Alzheimer's disease or vascular dementia in the VA, and were aged 65 and older. Generalized ordered logit models were used to estimate the effects of patient characteristics on use group over time. In 1998, 41.7% of the sample were VA-only users, 55.4% were dual users, and 2.9% were Medicare-only users. By 2001, 30.4% were VA-only users, 51.5% were dual users, and 18.1% were Medicare-only users. Multivariate results show that greater likelihood of Medicare use was associated with older age, being white, being married, having higher education, having private insurance or Medicaid, having low VA priority level, and living in a nursing home or dying during the year. Higher comorbidities were associated with greater likelihood of dual use as opposed to any single system use. Alternatively, number of functional limitations was associated with greater likelihood of Medicare-only use and less likelihood of VA-only use. These results imply that different aspects of veterans' needs have differential effects on where they seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure that patients receive high-quality care, especially patients with multiple comorbidities. [source] Critical care nurse practitioners and clinical nurse specialists interface patterns with computer-based decision support systemsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2007APRN (Assistant Professor of Health, Community Systems, Coordinator of the Nursing Education Graduate Program), PhD(c), Scott Weber EdD Abstract Purpose: The purposes of this review are to examine the types of clinical decision support systems in use and to identify patterns of how critical care advanced practice nurses (APNs) have integrated these systems into their nursing care patient management practices. The decision-making process itself is analyzed with a focus on how automated systems attempt to capture and reflect human decisional processes in critical care nursing, including how systems actually organize and process information to create outcome estimations based on patient clinical indicators and prognosis logarithms. Characteristics of APN clinicians and implications of these characteristics on decision system use, based on the body of decision system user research, are introduced. Data sources: A review of the Medline, Ovid, CINAHL, and PubMed literature databases was conducted using "clinical decision support systems,""computerized clinical decision making," and "APNs"; an examination of components of several major clinical decision systems was also undertaken. Conclusions: Use patterns among APNs and other clinicians appear to vary; there is a need for original research to examine how APNs actually use these systems in their practices in critical care settings. Because APNs are increasingly responsible for admission to, and transfer from, critical care settings, more understanding is needed on how they interact with this technology and how they see automated decision systems impacting their practices. Implications for practice: APNs who practice in critical care settings vary significantly in how they use the clinical decision systems that are in operation in their practice settings. These APNs must have an understanding of their use patterns with these systems and should critically assess whether their patient care decision making is affected by the technology. [source] Stochastic modeling of usage patterns in a web-based information systemJOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 7 2002Hui-Min Chen Users move from one state (or task) to another in an information system's labyrinth as they try to accomplish their work, and the amount of time they spend in each state varies. This article uses continuous-time stochastic models, mainly based on semi-Markov chains, to derive user state transition patterns (both in rates and in probabilities) in a Web-based information system. The methodology was demonstrated with 126,925 search sessions drawn from the transaction logs of the University of California's MELVYL® library catalog system (www.melvyl.ucop.edu). First, user sessions were categorized into six groups based on their similar use of the system. Second, by using a three-layer hierarchical taxonomy of the system Web pages, user sessions in each usage group were transformed into a sequence of states. All the usage groups but one have third-order sequential dependency in state transitions. The sole exception has fourth-order sequential dependency. The transition rates as well as transition probabilities of the semi-Markov model provide a background for interpreting user behavior probabilistically, at various levels of detail. Finally, the differences in derived usage patterns between usage groups were tested statistically. The test results showed that different groups have distinct patterns of system use. Knowledge of the extent of sequential dependency is beneficial because it allows one to predict a user's next move in a search space based on the past moves that have been made. It can also be used to help customize the design of the user interface to the system to facilitate interaction. The group CL6 labeled "knowledgeable and sophisticated usage" and the group CL7 labeled "unsophisticated usage" both had third-order sequential dependency and had the same most-frequently occurring search pattern: screen display, record display, screen display, and record display. The group CL8 called "highly interactive use with good search results" had fourth-order sequential dependency, and its most frequently occurring pattern was the same as CL6 and CL7 with one more screen display action added. The group CL13, called "known-item searching" had third-order sequential dependency, and its most frequently occurring pattern was index access, search with retrievals, screen display, and record display. Group CL14 called "help intensive searching," and CL18 called "relatively unsuccessful" both had third-order sequential dependency, and for both groups the most frequently occurring pattern was index access, search without retrievals, index access, and again, search without retrievals. [source] | |||||||||||||