Problem-orientation: an experimental study to test its heuristic value

Using a two-group before--after experimental design, this study explored the effect of problem-orientation on a nursing staff's ability to identify underlying patient problems. Nursing service staff members (registered nurses, licensed vocational nurses, and corps personnel) from two small naval hospitals who met the criteria for inclusion and consented to participate were utilized. Because of staff turnover, the composition of the groups differed from preto posttesting phases. The pretest sample consisted of 47 control/48 experimental subjects; the posttest sample included 38 control/39 experimental subjects. The experimental group was instructed on the independent variable, problem-orientation, by the investigator through a six-hour workshop on the problem-oriented nursing record after which the system was instituted in the experimental setting. After a five-month period posttesting was done to determine if changes had occurred. Analysis of the data supported the hypothesis that problem-orientation does, in fact, substantially increase a nursing staff's ability to identify patient problems. The incorporation of this system into nursing services could provide a vehicle for pinpointing underlying patient problems and dealing with them in a systematic way, thereby upgrading patient care.

Comparison of urinary excretion of tobramycin and gentamicin in adults

The urinary excretion of tobramycin and gentamicin was measured after intramuscular injections of 1 mg of each drug/kg in six normal volunteers. The antibiotics were assayed by the adenylyltransferase enzymatic method, which enables urine concentrations to be estimated accurately without dependence on urinary pH. The levels of the antibiotics in urine varied with the urine volume. The concentration of gentamicin was greater than 113 mug/ml and that of tobramycin was greater than 94 mug/ml 1 hr after administration. Urinary excretion of both antibiotics was rapid; 63.5% of the gentamicin and 74% of the tobramycin was excreted with 24 hr, with a large proportion being excreted by 4 hr after injection. There was a striking uniformity of individual values, and the method offers considerable advantages over existing microbiologic assays.