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PubMed2001

Working with low back pain: problem-solving orientation and function.

A number of ergonomic, workplace and individual psychosocial factors and health behaviors have been associated with the onset, exacerbation and/or maintenance of low back pain (LBP). The functional impact of these factors may be influenced by how a worker approaches problems in general. The present study was conducted to determine whether problem-solving orientation was associated with physical and mental health outcomes in fully employed workers (soldiers) reporting a history of LBP in the past year. The sample consisted of 475 soldiers (446 male, 29 female; mean age 24.5 years) who worked in jobs identified as high risk for LBP-related disability and reported LBP symptoms in the past 12 months. The Social Problem-Solving Inventory and the Standard Form-12 (SF-12) were completed by all subjects. Hierarchical multiple regression analyses were used to predict the SF-12 physical health summary scale from interactions of LBP symptoms with each of five problem-solving subscales. Low scores on positive problem-solving orientation (F(1,457)=4.49), and high scores on impulsivity/carelessness (F(1,457)=9.11) were associated with a steeper gradient in functional loss related to LBP. Among those with a longer history of low-grade LBP, an avoidant approach to problem-solving was also associated with a steeper gradient of functional loss (three-way interaction; F(1,458)=4.58). These results suggest that the prolonged impact of LBP on daily function may be reduced by assisting affected workers to conceptualize LBP as a problem that can be overcome and using strategies that promote taking an active role in reducing risks for LBP. Secondary prevention efforts may be improved by addressing these factors.

Adult↗

PubMed2004

Cognitive factors in student nurses' clinical problem solving.

RATIONALE, AIMS AND OBJECTIVES: The assumption that the acquisition and mastery of the nursing process alone is sufficient to explain problem-solving performance has been challenged in recent literature. Researchers have argued that the quality of prior knowledge is a key component in explaining performance. In addition, motivational orientation and the quality of reasoning have been found to have different effects on performance in cognitive tasks. The aim of this study is to explore student nurses' clinical problem solving based on a model consisting of their motivational orientation, prior knowledge, diagnostic reasoning and diagnostic solutions. METHODS: One hundred and thirty-five second-year nursing students completed the Study Process Questionnaire and the Causal Attribution Questionnaire prior to receiving five lectures on mental illness. A knowledge test and a clinical problem-solving task provided measures of prior knowledge, quality of diagnostic reasoning, and the quality and comprehensiveness of nursing diagnosis. A correlational design using pairwise correlations, hierarchical regression and path analysis examined the relationships among these data. RESULTS AND CONCLUSIONS: The results indicated an important role for a belief in personal control, for the accessibility and structuring of prior knowledge, and the quality of diagnostic reasoning, in generating high quality and comprehensive nursing diagnoses. The findings suggest that all contributing components of clinical problem solving need to be addressed in nursing education.

Adolescent↗

PubMed2001

Social problem-solving abilities and personality disorder characteristics among dual-diagnosed persons in substance abuse treatment.

We examined the relation of self-appraised social problem-solving abilities and personality-disorder characteristics to the adjustment and compliance of persons with dual diagnoses in substance-abuse treatment. It was hypothesized that elements of the problem-orientation component would remain predictive of depressive behavior and distress after considering personality-disorder characteristics among 117 persons receiving inpatient-substance-abuse treatment. Furthermore, self-appraised problem-solving abilities were expected to predict the occurrence of "dirty" drug and alcohol screens during treatment and compliance with the first scheduled community follow-up visit. Results supported predictions concerning the relation of problem-solving confidence to depressive behavior, distress, and substance-use screens; however, a paradoxical relation was observed between the problem-orientation variables and compliance with the first outpatient visit. The results are interpreted within the context of contemporary models of social problem solving and the implications for cognitive-behavioral assessment and intervention are considered.

Adult↗

PubMed1990

Problem-solving deficits in suicidal patients: trait vulnerability or state phenomenon?

A diathesis-stress model has been proposed (Schotte & Clum, 1982, 1987), in which deficits in interpersonal problem-solving skills are said to predispose individuals under chronic stress to depression, hopelessness, and suicide ideation. The present study examined the stability of interpersonal problem-solving skills in a short-term, longitudinal study of hospitalized suicide ideators (N = 36). The Ss displayed marked changes in depressive symptoms, state anxiety, hopelessness, and suicide intent over time, and these improvements were associated with improvements in interpersonal problem-solving skills. It is concluded that interpersonal problem-solving deficits may be a concomitant, rather than a cause, of depression, hopelessness, and suicide intent.

Adult↗

PubMedDate not supplied

A do-it-yourself guide to group problem solving.

The use of QC (quality control) circles and other group problem-solving techniques has been hindered by a general lack of group-process skills among managers and prospective group leaders, according to author Ernesto Poza, president of E. J. Poza Associates, Inc. Thus many organization feel they must hire consultants to help implement group processes--an expensive prospect indeed. As he explains here, however, the author has developed a five-step do-it-yourself approach that will enable employee groups to solve organizational problems on their own. With the aid of his step-by-step explanation, human resources managers should gain enough "expertise" to use this approach themselves and to train others to use it. The steps include problem identification, brain-storming, cause-and-effect analysis, force-field analysis, and action planning and implementation.

Group Processes↗

PubMed1996

The relationship between anxiety and problem-solving skills in children with and without learning disabilities.

This study compared the effects of low, medium, and high pretest anxiety levels on the social and nonsocial problem-solving performance of 45 boys with learning disabilities (LD) and 45 boys with no learning disabilities (NLD). Participants ranged from 9 to 11 years of age. Boys with LD reported significantly higher pretest trait and state anxiety on the State-Trait Anxiety Inventory for Children than did NLD boys, and their perceived state anxiety escalated over the course of the problem-solving session. There were no pervasive effects of LD status on problem solving by itself, boys with LD being as effective in problem solving as NLD boys. However, means for task solution suggest a tendency for an interaction between group and anxiety level, which should be examined using a larger, well-defined sample and an unstructured task.

Achievement↗

PubMed1985

An emergency medicine clinical problem-solving system.

The availability of complete, accurate, and current medical information is an important aspect of clinical problem solving. As the body of medical information grows and increasingly is reformatted into problem-oriented references, information processing by physicians will grow in importance. The most popular clinical problem-solving method, the Weed problem-oriented medical record, primarily records information; it does not provide an explicit information-processing model. An emergency medicine clinical problem-solving system containing information recording and processing methodologies is presented. The information processing methodology of this system is highlighted.

Emergency Medicine↗

PubMed1994

Interpersonal problem-solving skills training in the treatment of self-poisoning patients.

The present study evaluated the effectiveness of interpersonal problem-solving skills training (IPSST) for the treatment of self-poisoning patients. Thirty-nine self-poisoning patients were assigned randomly either to IPSST or to a control treatment condition (a brief problem-oriented approach). Both conditions were equally effective in reducing the number of presenting problems and in reducing hopelessness levels. However, the IPSST condition was significantly more effective than the control condition as determined by other outcome measures (measures of interpersonal cognitive problem solving, self-rated personal problem-solving ability, perceived ability to cope with ongoing problems, and self-perception). Follow-up studies showed maintenance of IPSST treatment gains at 6 months and a greater reduction of repetition of self-poisoning in the IPSST group at 1 year posttreatment.

Adolescent↗

PubMed1992

Autobiographical memory and problem-solving strategies of parasuicide patients.

Recent research has noted the tendency of parasuicide patients to retrieve over-general autobiographical memories. Separate studies suggest problem-solving deficits within this group. The present study was concerned first with replicating these findings and, secondly, with developing a model of the relationship between over-general memory recall and poor problem-solving abilities in parasuicide patients. Anger and hopelessness were measured as markers for mood. In line with the hypotheses, the parasuicide group (N = 12) produced significantly over-general memories in contrast to a matched control group (N = 12). This occurred significantly in relation to positive cues, and latency to first responses was significantly delayed in the parasuicide group. The parasuicide group also provided fewer and less-effective problem-solving strategies than the control group, and a significant association was found between low effectiveness of problem-solving strategies and over-general memory recall in the parasuicide group. Anger and hopelessness levels were significantly higher within the parasuicide group in line with previous findings. The clinical implications of these findings are discussed.

Adaptation, Psychological↗

PubMed2004

Working memory and phonological processing as predictors of children's mathematical problem solving at different ages.

The study explored the contribution of working memory (WM) to mathematical problem solving in younger (8-year-old) and older (11-year-old) children. The results showed that (1) significant age-related differences in WM performance were maintained when measures of phonological processing (i.e., digit naming speed, short-term memory, phonological deletion) were partialed from the analysis; (2) WM predicted solution accuracy of word problems independently of measures of problem representation, knowledge of operations and algorithms, phonological processing, fluid intelligence, reading, and math skill; and (3) a second-order WM factor was correlated with problem solving, suggesting that a general or executive system underlies age-related performance. The results were interpreted as support for the notion that the executive system was an important predictor of age-related changes in problem solving beyond the contribution of math and reading skills, and this system operates independently of the phonological system and domain-specific knowledge in predicting solution accuracy.

Age Factors↗

PubMed2001

Case management services for work related upper extremity disorders. Integrating workplace accommodation and problem solving.

A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.

Arm↗

PubMed2002

Abnormal gaze strategies during problem solving in Parkinson's disease.

We have taken a novel approach to the study of problem solving involving the detailed analysis of natural scanning eye movements during the 'one touch' Tower of London task. Control subjects and patients with idiopathic Parkinson's disease (PDs) viewed a series of pictures depicting two arrangements of coloured balls in pockets within the upper and lower halves of a computer display. The task was to plan (but not execute) the shortest movement sequence required to rearrange the balls in one half of the display (the Workspace) to match the arrangement in the opposite half (the Goalspace) and indicate the number of moves required for problem solution. As problem complexity increased, control subjects spent proportionally more time fixating the Workspace region. This pattern was found regardless of whether subjects were instructed to solve problems by rearranging balls in the lower or upper visual fields. The distribution of gaze within the Workspace was also found to be problem dependent, with gaze being selectively directed towards the problem critical balls. In contrast, PDs were found to make more errors in the task and failed to show any dissociation in the amount of time fixating the two halves of the display. This pattern suggests that the patients had difficulty in encoding and/or maintaining current goals during problem solving, consistent with a role for fronto-striatal circuits in mechanisms of working memory and attention.

Aged↗

PubMed1999

Creative problem-solving: an approach to generating ideas.

An excellent starting point for exercising creativity is the area of problem solving. With a bag of creative problem solving tools and techniques, problems will no longer represent setbacks but instead, opportunities to introduce innovations that will support the company's initiative of continuous improvement.

Creativity↗

PubMed1984

Paradigms and problem-solving: a literature review.

Thomas Kuhn's conceptions of the influence of paradigms on the progress of science from the framework for analyzing how medical educators have approached research on medical problem-solving. Kuhn's ideas help to explain the often conflicting research results that have appeared over the last 20 years. Specifically, underlying assumptions about the problem-solving process are explored in light of data that demonstrate (a) low correlations between different measures of problem-solving, (b) inconsistent relationships between the amount of clinical experience and problem-solving ability, and (c) case specificity of performance. A new paradigm emphasizing multiple types of problems with varied solution strategies is proposed.

Clinical Competence↗

PubMed1995

Discrimination of cortical from subcortical dementias on the basis of memory and problem-solving tests.

This study compared the discriminative utility of problem-solving and memory tasks in patients with Alzheimer's and Huntington's disease and in age-, education-, and gender-matched normal control subjects. Problem-solving was assessed with a modified version of the Wisconsin Card Sorting Test. Memory was measured with a 10-item, 6-trial version of the Buschke Selective Reminding Test. Receiver Operating Characteristic curves were plotted to determine which measure provided the highest sensitivity (i.e., hit rate) and specificity (i.e., correct rejection rate). Both tests provided excellent detection of dementia (88 to 98% classification accuracy), but were less robust in differentiating between dementia groups. Findings underscore the suitability of both measures to detect mild dementia, but emphasize the importance of specific memory measures to differentiate between cortical and subcortical dementia.

Adult↗

PubMed2004

A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care.

OBJECTIVE: To study time course changes in knowledge, problem solving ability, and quality of life in patients with type 2 diabetes managed by group compared with individual care and education. RESEARCH DESIGN AND METHODS: We conducted a 5-year randomized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit. There were 120 patients with non-insulin-treated type 2 diabetes enrolled and randomly allocated to group or individual care. Eight did not start and 28 did not complete the study. The main outcome measures were knowledge of diabetes, problem solving ability, quality of life, HbA1c, BMI, and HDL cholesterol. RESULTS: Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects (P<0.001 for both). Quality of life improved from year 2 with group care but worsened with individual care (P<0.001). HbA1c level progressively increased over 5 years among control subjects (+1.7%, 95% CI 1.1-2.2) but not group care patients (+0.1%, -0.5 to 0.4), in whom BMI decreased (-1.4, -2.0 to -0.7) and HDL cholesterol increased (+0.14 mmol/l, 0.07-0.22). CONCLUSIONS: Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and settings tailored to their needs. Traditional one-to-one care, although delivered according to optimized criteria, is associated with progressive deterioration of knowledge, problem solving ability, and quality of life. Better cognitive and psychosocial results are associated with more favorable clinical outcomes.

Blood Glucose↗

PubMed1991

Empowering middle managers in hospitals with team-based problem solving.

A team-oriented problem-solving procedure using management project teams was developed to improve quality of care and productivity in a private, nonprofit hospital. A focus group of managers developed the procedure, endorsed by top management. The work of four manager teams that followed the procedure saved the hospital more than $500,000.

Decision Making, Organizational↗

PubMed1984

Information needs and problem solving behavior of parents of infants.

Two approaches were used to investigate the problems or issues that parents of infants encounter: the study of circumstances that are naturally recognized by the parent as an issue, and the study of simulated problems concerning commonly occurring infant care issues. A paradigm of problem solving behavior was used to formulate the component of a descriptive study for the purpose of examining the problem solving behavior of mothers during their infants' first 3 months. Mothers who participated in both studies were married or living with a partner, were 17 years or older, and had healthy infants. The objective of the first study was to capture in the mothers' own terms their specification and description of the issues on which they were working and the nature of the infant care task, including the types of help mothers used and the stressors and supports they experienced. Logs were used by 62 mothers (38 primiparae and 24 multiparae) for 90 days after their infants' births to record these issues, types of help, stressors, and supports. Predetermined categories were used to code the data. The type of help used varied significantly by category of issue. Books were used most frequently for issues of growth and development and baby care, and they were used more often than all types of clinicians combined for these types of issues. For over one-third of issues, no help of any type was used. Multiparae and primiparae did not differ significantly in the total number of issues reported, nor in the frequency with which help was used. The objective of the second study was to examine the types of goals and decision making rules that mothers applied to two simulated infant care problems: one concerning the amount of the feeding, and the second concerning noncontingent crying. Four simulated problem exercises were presented to 22 mothers (14 primiparae and 8 multiparae), using a telephone interview in the infants' first 3 months. The results of the study revealed that mothers gave a variety of names to the same problem. The types of goals that mothers identified varied by type of problem. More mothers cited competence as a goal for the crying than the feeding problem. More mothers were able to state the decision rule they had used for naming the problem than for choice of action to solve the problem (implementing).(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗