136 research outputs found

    Careful and Complete Observation of the Patient: Nurses and the Sociotechnical System of Medical Research, 1930-1962

    Get PDF
    ABSTRACT CAREFUL AND COMPLETE OBSERVATION OF THE PATIENT;” NURSES AND THE SOCIOTECHNICAL SYSTEM OF MEDICAL RESEARCH, 1930-1962 Amanda L. Mahoney, MS, RN Julie A. Fairman, PhD, RN, FAAN This study addresses the history of nurses working in medical research between 1930 and 1962, a time of tremendous growth in the use of experimentation to further clinical knowledge. Nurses were part of an intricate network of people, machines, knowledge and space—a socio-technical system—that made the clinical discoveries of the mid-20th century possible. Nurses were heavily involved in the day to day practices of medical research, thus this dissertation employs a microhistory approach, focusing on individual research projects conducted at the Hospital of the University of Pennsylvania (HUP) in Philadelphia, Pennsylvania. Archival sources related to clinical trials and nursing at HUP were examined as well as the historical records of funding agencies. Nurses performed important, skilled tasks including data collection and complex patient care. The requirements of research studies as well as the new technologies associated with clinical trials required nurses to develop methods and systems to accommodate an increased work load, collect data, and implement new treatments and techniques. This knowledge work was performed in the busy, understaffed world of the mid-20th century hospital. Nurses provided close observation and careful control of the patient, making metabolic research in particular feasible within hospitals. Nurses maintained the cooperation of research patients, a critical aspect to studies involving special diets. Within the hospital, nurses created a “zone of control” around the bedside of research patients, implementing research protocols, closely observing patients and gaining their compliance or cooperation. Using the work of bedside nurses as a historical lens reveals much about the world of medical research and the many factors that contributed to the growth and acceptance of experimentation as a normal part of clinical medicine. Marginalized actors have the agency and power to influence the success or failure of medical research even if they are denied official power. Nursing may hold the solutions to many of the challenges researchers face today

    Accidental awareness during general anaesthesia in obstetric surgery

    Get PDF
    Accidental awareness during general anaesthesia (AAGA) occurs when a patient becomes unintentionally conscious during general anaesthesia, which may involve unpleasant memories of experiences during surgery. Contributory factors that may increase risk of AAGA coincide in pregnant women undergoing general anaesthesia for childbirth related surgery. Whilst obstetric general anaesthesia has largely been substituted by spinal and epidural (termed neuraxial) anaesthetic techniques, in which a mother can be awake and pain free during childbirth, general anaesthesia is still necessary to facilitate surgery rapidly in emergency situations or for mothers with certain medical conditions. In this thesis I investigate the distinct characteristics of general anaesthesia for pregnant women undergoing surgery for childbirth, whether these characteristics increase risk of AAGA, and changes to obstetric anaesthetic technique occurring in the context of wider anaesthetic developments over time. I provide evidence on the incidence, experiences, risk factors and psychological consequences of AAGA in peripartum women. Challenges to large scale clinical study of AAGA are explored and addressed in the design of a multi-centre, prospective, cross-sectional cohort study of women receiving general anaesthesia for obstetric surgery in 72 hospitals in England. A four-stage process for screening patients using direct questioning, verifying with corroborative detail, adjudicating and classifying descriptions of experiences is described. The interactional nature of research interviews, statistical modelling, psychological factors and the neurophysiology of memory are considered during development of study methodology. Psychological morbidity was assessed for 12 months after surgery. As part of an embedded study, descriptive epidemiology of obstetric patients and general anaesthesia techniques were identified, alongside risk factors for airway complications. A total of 3,115 patients were recruited, 12 of whom had certain/probable or possible AAGA: a prevalence of 0.39% or 1 in 256 (95%CI 149–500) for all obstetric surgery. Distressing experiences were reported by seven (0.22%) patients, paralysis by five (0.16%) and paralysis with pain by two (0.06%). Associations were identified between AAGA and patient risk factors (abnormal body mass index), organisational factors (out-of-hours surgery) and pharmacological factors (use of thiopental during induction of anaesthesia). Contextual factors relating anaesthesia for obstetric patients with AAGA and other anaesthesia complications, including difficult airway management, were evaluated. My study methodology and it’s context, in English public sector hospitals, identified a higher risk of AAGA in obstetric patients than previously detected using other methods and locations. These results have implications for healthcare policy of obstetric anaesthesia, informed consent of patients receiving general anaesthesia and post-natal screening care. I conclude on recommendations to minimise awareness risk for future patients and address the challenge of implementing systemic improvements in obstetric general anaesthesia care and patient safety

    Les résumés de la Conférence canadienne sur l'éducation médicale 2021

    Get PDF

    INSTRUCTIONAL DESIGN, IMPLEMENTATION STRATEGIES, AND EVALUATION OF ANES 525 APPLIED ANATOMY FOR ANESTHESIA PRACTICE: TRANSFORMATION OF A DISSECTION-BASED BASIC SCIENCE COURSE INTO A TECHNOLOGY AND CLINICALLY BASED ANATOMY COURSE FOR ANESTHESIOLOGIST ASSISTANT STUDENTS

    Get PDF
    Due to perceived economic drain on Emory University Anesthesiologist Assistant (AA) Program resources, faculty, and students, administrators called for the anatomy course to eliminate cadaver laboratory. Simultaneously, administrators encouraged faculty to design AA courses with regard to the progressive medical education pedagogic transition from traditional lecture hall dissemination of information toward experiential learning via problem-based learning (PBL) and authentic activities. Additionally, progressive medical educators advocate for inclusion of medical technology in both clinical and didactic learning environments. So although dissection of cadavers has historically been the cornerstone of anatomy instruction, advancements in medical imaging, virtual cadaver software, and digital learning media suggest that a flipped and blended course of human anatomy is possible. This study documents the transformation of a graduate level dissection-based basic science course into a technology and clinically based anatomy course. Student achievement measured via pre/posttest design demonstrated significant increases in scores, which indicates that learning occurred. Student perceptions of teaching and learning materials and instructional methods measured by a Likert-type survey questionnaire revealed learning preferences and attitudes, and showed significant correlations between key questions to support instrument validity

    Yale Medicine : Alumni Bulletin of the School of Medicine, Fall 1994- Summer 1996

    Get PDF
    This volume contains Yale medicine: alumni bulletin of the School of Medicine, v.29 (Fall 1994) through v.30 (Summer 1996). Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes are called Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965). Digitized with funding from the Arcadia fund, 2017.https://elischolar.library.yale.edu/yale_med_alumni_newsletters/1012/thumbnail.jp

    Patient Safety and Quality: An Evidence-Based Handbook for Nurses

    Get PDF
    Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement
    • …
    corecore