Incorrect Instructions Research Articles

Variabilidade comportamental em humanos: efeitos de regras e contingências

Dois experimentos investigaram, com estudantes universitários, a variabilidade aprendida. No Experimento 1, quatro grupos (n = 5) foram submetidos a dois esquemas de reforçamento para seqüências de respostas de pressão às teclas P e Q do computador. Para o grupo Variabilidade (VAR) o reforçamento era dependente do alto grau de variação entre as seqüências, e para o grupo Acoplado (ACO) o reforçamento independia dessa variabilidade. Foram manipuladas a ordem de apresentação dessas contingências e o intervalo entre elas (0 e 3 meses). No Experimento 2, essas contingências foram combinadas a instruções verbais (regras) que as descreviam correta ou incorretamente (quatro grupos, n = 5). Os resultados mostraram: 1) maior variabilidade em VAR, independente das demais variáveis manipuladas, 2) desempenho em ACO afetado parcialmente pela ordem das contingências, pelo intervalo e pelas regras. Em ambos os estudos, os sujeitos não foram capazes de descrever as contingências em vigor. Esses resultados indicam o controle operante da variabilidade observada.

Correspondence Between Instructions, Performance, and Self-Descriptions in A Conditional Discrimination Task: The Effects of Feedback and Type of Matching Response

Four experiments were designed to evaluate the functional correspondence of effective performance with correct or incorrect instructions and correct or incorrect self-descriptions in a first-order matching-to-sample task. These studies included verbal or nonverbal matching responses and provided feedback or not after the participants described their matching performance. The results point to three possible discrimination learning processes in humans: (1) learning through instructions, with a possible insensitivity to consequences unless the correspondence between instructions and feedback breaks down; (2) learning through feedback, with an inability of participants to describe their own behavior; and (3) a genuine “rule-governed” behavior consisting of successful task performance and explicit verbal behavior describing the actual contingencies effective for such performance.

Evaluation of compliance with a computerized protocol: Weaning from mechanical ventilator support using pressure support

Study objectives: To use a computerized consultation system to evaluate the feasibility of a mechanical ventilator weaning protocol which used the rapid shallow breathing index to guide adjustments in pressure support. A program to monitor user compliance and reasons for noncompliance was built into the computerized consultation system. Methods: A total of nine critically ill patients (ten weaning episodes) were enrolled in the protocol. The respiratory therapists performed routine computer charting in the electronic database. They accepted or declined the explicit instructions generated by the computerized protocol and displayed on the bedside terminal. The consultation program monitored whether accepted instructions were implemented by the user. Results: Patient's therapy was controlled by protocol for a total of 1075 h (mean 108 h, range 4 to 339 h) and 94.8% (1321/1394) of instructions were followed by the clinical staff. Of the 42 instructions clinical staff refused to follow, 23 (55%) were extubation instructions. There were 52 (3.7%) incorrect instructions generated with 24 software errors, 21 errors in underlying logic, and seven user misunderstanding errors. Conclusions: A high level of user compliance with this protocol was achieved. The methods described herein to monitor compliance and reasons for noncompliance within a protocol are reusable in the domain of mechanical ventilation and possibly in other domains.

Performance of computerized protocols for the management of arterial oxygenation in an intensive care unit

Computerized protocols were created to direct the management of arterial oxygenation in critically ill ICU patients and have now been applied routinely, 24 hours a day, in the care of 80 such patients. The protocols used routine clinical information to generate specific instructions for therapy. We evaluated 21,347 instructions by measuring how many were correct and how often they were followed by the clinical staff. Instructions were followed 63.9% of the time in the first 8 patients and 92.3% in the subsequent 72 patients. Instruction accuracy improved after the initial 8 patients, increasing from 71.5% of total instructions to 92.8%. Instruction inaccuracy was primarily caused by software errors and inaccurate and untimely entry of clinical data into the computer. Software errors decreased from 7.2% in the first 8 patients to 0.8% in subsequent patients, while data entry problems decreased from 7.5% to 4.2%. We also assessed compliance with the protocols in a subset of 12 patients (2637 instructions) as a function of 1) the mode of ventilatory support, 2) whether the instruction was to increase or decrease the intensity of therapy or to wait for an interval of time and 3) whether the instruction was 'correct' or 'incorrect'. The mode of ventilatory support did not affect compliance with protocol instructions. Instructions to wait were more likely to be followed than instructions to change therapy. Ninety-seven percent of the correct instructions were followed and 27% of the incorrect instructions were followed.(ABSTRACT TRUNCATED AT 250 WORDS)