Refining Terminology as a Prelude to Decision Modeling in the Clinical Setting: An Application in the NICU

2.50
Hdl Handle:
http://hdl.handle.net/10755/156847
Type:
Presentation
Title:
Refining Terminology as a Prelude to Decision Modeling in the Clinical Setting: An Application in the NICU
Abstract:
Refining Terminology as a Prelude to Decision Modeling in the Clinical Setting: An Application in the NICU
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:June, 2001
Author:Panniers, Teresa
P.I. Institution Name:New York University
Objective: We intend to model decisions made by neonatal nurse practitioners (NNPs) when initiating oral feedings in preterm infants cared for in the NICU with the goal of developing an automated decision support system (DSS). To model decisions that will form the basis for a DSS, the clinical terms used as data input must be specified precisely. Since terms related to the concept of oral feeding found in the literature are so variable and do not always include explicit definitions, we have undertaken an ethnography to elucidate terms used to describe and define treatment choices related to feeding preterm infants in a NICU. Design: This study was conducted using a qualitative design. Population, Sample, Setting, Years: An interdisciplinary neonatology team caring for preterm infants in a Level III NICU in a Mid-Atlantic medical center in the US formed the participant focus of this study. The study was conducted over an eight-month period during 1999-2000. Concepts Studied: The concepts studied were clinical decision-making and infant nutrition. Methods: An ethnographic study was conducted. Initially, participant observation of the neonatology team was conducted during morning report and rounds. Subsequently, in-depth, unstructured ethnographic interviews were conducted with an expert NNP. Findings: The findings show that oral feeding is a term that is associated with the domain of Infant Nutrition and is one of two broad categories of treatment choices within this domain: Oral Feeding and Intravenous Feeding. Each of these treatment choices is further broken down into more specific treatment choices. Specifically, under the rubric of Oral Feeding are the treatment choices of Nipple Feeding, Breast Feeding, Gavage Feeding, and Transpyloric Feeding. As treatment choices, Nipple Feeding, Transpyloric Feeding and Breast Feeding stand alone without further descriptors. Gavage Feeding includes Bolus mode and Continuous mode as further descriptors of this method of feeding. For Intravenous Feeding, there are two types described: Peripheral and Central. In addition to describing treatment choices for the phenomenon of Infant Nutrition, definitions of each term are gleaned from the ethnographic data. Conclusions: Our ethnographic study has revealed the complexity surrounding how clinicians define the concept of feeding for preterm infants in the NICU. In the clinical setting this depiction of the phenomenon of oral feeding places it appropriately in its broader context while adding a level of clarity for communicating about the nutritional care of neonates. For developing automated decision support systems, it can provide the clinician and the researcher with clear, unambiguous terminology when initiating decision models for complex clinical problems. Implications: Understanding decisions surrounding the timing and implementation of oral feedings in preterm infants can enable better outcomes including earlier discharge from the neonatal intensive care unit (NICU). The development of automated DSS to support clinical decisions offers the opportunity to enhance the quality of care received by preterm infants who represent some of our most fragile patients.
Repository Posting Date:
26-Oct-2011
Date of Publication:
Jun-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleRefining Terminology as a Prelude to Decision Modeling in the Clinical Setting: An Application in the NICUen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156847-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Refining Terminology as a Prelude to Decision Modeling in the Clinical Setting: An Application in the NICU</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">June, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Panniers, Teresa</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">New York University</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">tlp2@nyu.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: We intend to model decisions made by neonatal nurse practitioners (NNPs) when initiating oral feedings in preterm infants cared for in the NICU with the goal of developing an automated decision support system (DSS). To model decisions that will form the basis for a DSS, the clinical terms used as data input must be specified precisely. Since terms related to the concept of oral feeding found in the literature are so variable and do not always include explicit definitions, we have undertaken an ethnography to elucidate terms used to describe and define treatment choices related to feeding preterm infants in a NICU. Design: This study was conducted using a qualitative design. Population, Sample, Setting, Years: An interdisciplinary neonatology team caring for preterm infants in a Level III NICU in a Mid-Atlantic medical center in the US formed the participant focus of this study. The study was conducted over an eight-month period during 1999-2000. Concepts Studied: The concepts studied were clinical decision-making and infant nutrition. Methods: An ethnographic study was conducted. Initially, participant observation of the neonatology team was conducted during morning report and rounds. Subsequently, in-depth, unstructured ethnographic interviews were conducted with an expert NNP. Findings: The findings show that oral feeding is a term that is associated with the domain of Infant Nutrition and is one of two broad categories of treatment choices within this domain: Oral Feeding and Intravenous Feeding. Each of these treatment choices is further broken down into more specific treatment choices. Specifically, under the rubric of Oral Feeding are the treatment choices of Nipple Feeding, Breast Feeding, Gavage Feeding, and Transpyloric Feeding. As treatment choices, Nipple Feeding, Transpyloric Feeding and Breast Feeding stand alone without further descriptors. Gavage Feeding includes Bolus mode and Continuous mode as further descriptors of this method of feeding. For Intravenous Feeding, there are two types described: Peripheral and Central. In addition to describing treatment choices for the phenomenon of Infant Nutrition, definitions of each term are gleaned from the ethnographic data. Conclusions: Our ethnographic study has revealed the complexity surrounding how clinicians define the concept of feeding for preterm infants in the NICU. In the clinical setting this depiction of the phenomenon of oral feeding places it appropriately in its broader context while adding a level of clarity for communicating about the nutritional care of neonates. For developing automated decision support systems, it can provide the clinician and the researcher with clear, unambiguous terminology when initiating decision models for complex clinical problems. Implications: Understanding decisions surrounding the timing and implementation of oral feedings in preterm infants can enable better outcomes including earlier discharge from the neonatal intensive care unit (NICU). The development of automated DSS to support clinical decisions offers the opportunity to enhance the quality of care received by preterm infants who represent some of our most fragile patients.</td></tr></table>en_GB
dc.date.available2011-10-26T15:11:51Z-
dc.date.issued2001-06en_GB
dc.date.accessioned2011-10-26T15:11:51Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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