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PubMed1978

A systematic approach to medical technology curriculum development.

A systematic approach to medical technology curriculum development resulted from a multidisciplinary, federally funded, competency-based curriculum development project in the School of Allied Medical Professions at The Ohio State University. This approach includes processes for identifying medical technology competencies, evaluating the effectiveness of an ongoing curriculum, and developing a domain-referenced framework for organizing, sequencing, evaluating, and updating the requisite professional knowledge, skills, and attitudes.

Competency-Based Education↗
PubMed2000

Competency standards in the context of infection control.

BACKGROUND: To ensure quality patient care and enhance career development, competency levels of infection control professionals (ICPs) need to be identified and strengthened so that high standards of practice are established and maintained. OBJECTIVE: The purpose of this study was to apply a modified version of Benner's (1984) "Novice to Expert" model of skill acquisition to levels of competency and to seek to measure practices of the specialist practitioner in the context of infection control. METHOD: A self-administered questionnaire was developed and mailed to 464 members of the Infection Control Association, New South Wales (NSW) Inc, Australia. RESULTS: Seventeen percent of respondents reported full-time infection control responsibilities, 78% part time, and 5% unknown. The sample comprised 4 groups of ICPs. The largest groups were registered nurses, representing 37% of total respondents and "Other health care professionals" representing 35%. Forty-nine percent of the sample had completed a basic or advanced infection control certificate course, 21% had completed a bachelor of nursing or health science degree, and 21% had completed other studies not related to the specialty. Key findings of this study indicated that the clinical nurse consultant group rated their individual levels of skills and knowledge as proficient (competent). Although a small percentage from this group had completed higher level education, years of service within the specialty contributed to an increase in competent performance. This was also applicable to the other groups studied. CONCLUSION: The findings highlighted the need for a framework to be developed on which to build a model to measure and reflect progression of infection control competence at the beginner, advanced beginner, competent, and expert levels. Continuing education as a means of achieving competence needs to be further developed, maintained, and nurtured so that the ICP can acquire appropriate specialty knowledge and skills.

Education, Nursing, Continuing↗
PubMed2006

Enhancing nursing students' clinical placement experiences: a quality improvement project.

Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students' clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians' perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues. Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates' readiness for practice. Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made.

Attitude of Health Personnel↗
PubMed2026

Beyond risk factors: A capacity framework for cancer survivorship research.

Cancer survivorship research has identified numerous biological, behavioral, psychosocial, health care, and structural factors that influence recovery. However, these factors are typically studied as separate determinants rather than interacting influences. This commentary proposes available survivorship capacity as a unifying framework that explains how these diverse determinants collectively shape recovery and survivorship outcomes. Concepts from geroscience, health care delivery, rehabilitation, occupational therapy, and human factors science were synthesized to develop a conceptual framework of available survivorship capacity. The framework conceptualizes recovery as a function of the capacity remaining after competing health care and life demands draw upon survivors' finite physical, cognitive, emotional, social, financial, temporal, and health care resources. It generates testable propositions for measurement, intervention research, health care delivery, and implementation science while positioning available survivorship capacity as a common mechanism linking diverse determinants of recovery and identifying actionable targets for intervention. Available capacity offers a unifying conceptual framework for understanding heterogeneity in survivorship outcomes and intervention effectiveness while generating a research agenda for future survivorship science. Measuring and strengthening survivors' available capacity, while reducing unnecessary demands, may improve engagement in care, health behaviors, and long-term recovery.

Humans↗
PubMed2006

[The German competence network stroke: researching -- promoting -- networking].

BACKGROUND: Stroke is the most frequent neurologic disease, one of the most frequent reasons for disability and the third most frequent cause of death in Germany. Only the coordination of prevention, therapy in the acute setting and rehabilitation will improve the socioeconomic burden of stroke. IMPLEMENTATION AND RESULTS: The Competence Net Stroke (www.schlaganfallnetz.de) substantially contributes to these efforts by linking leading research groups together, improving communication, exchanging knowledge between clinicians, researchers and patients, as well as advancing public health science and quality assurance. Since the initiation of the Competence Net Stroke by the German Ministry of Education and Research in 1999, researchers and clinicians have implemented and expanded corporate databanks that jointly answer pressing questions in stroke imaging, epidemiology, and genetics. The progress that has been made is largely due to the formation of joint standard protocols at several independent institutions. The multicenter approach enabled the competence net to build up specialized criteria in magnetic resonance imaging (MRI). These criteria guide the clinician to those patients, who profit from thrombolysis beyond the 3-h time window. In addition, the Competence Net Stroke succeeded in reliably detecting cerebral hemorrhage with MRI. PROGRESSION AND PERSPECTIVES: Since 2005, and the beginning of the third funding period, the Competence Net Stroke consists of nine sub-nets. The integrative, rather than dominating, structure eases flexible reactions to new developments and findings in research. The Competence Net Stroke can more straightforwardly adopt new, promising research areas and end funding of those which are unsuccessful. The future and continuity of the Competence Net Stroke are secured by the acquisition of alternative funding such as "Sonderforschungsbereiche", the sixth European framework program, industrial partners, and health insurance.

Clinical Competence↗
PubMed1989

Autonomy in adolescent medicine. A framework for decisions about life-sustaining treatment.

A broad consensus has been reached in the last decade about the appropriateness of decisions to withhold life-sustaining treatment from competent adult patients. The situation in adolescent medicine is not so straightforward. Legal ambiguity in determining competence and clinical difficulty in assessing decision-making capacity make such decisions in adolescent medicine problematic. A framework for making decisions about withholding or withdrawing life-sustaining therapy from adolescent patients is proposed, and cases are given to illustrate the way the framework may be applied.

Adolescent↗
PubMedDate not supplied

Education for the advanced practice of clinical nurse specialists.

The results of an ethnographic study of the expert practice of clinical nurse specialists (CNSs) can be used to develop a curriculum based on the actual clinical competencies and skilled performance of successful CNSs. Benner's seven domains of expert clinical nurse practice formed the conceptual framework for an investigation that confirmed that expert CNSs demonstrate those domains as well as additional clinical, educational, and consultative competencies specific to the role. Several examples from the practice of oncology CNSs are included. Incorporating these findings into graduate education learning experiences would ensure that new graduates of CNS programs have a grasp of the realistic as well as the theoretical aspects of the role.

Clinical Competence↗
PubMed1998

Valuation of Ecological Resources and Functions

/ Ecological resources are natural resources that provide certain necessary but overlooked system maintenance functions within ecosystems. Environmental economics is in search of an appropriate analysis framework to determine economic values of such resources. This paper presents a framework that estimates and compiles the components of value for a natural ecosystem. The framework begins with the ecological processes involved, which provide functions within the ecosystem and services valued by humans. We discuss the additive or competive nature of these values, and estimate these values through conventional and unconventional techniques. We apply the framework to ecological resources in a shrub-steppe dryland habitat being displaced by development. We first determine which functions and services are mutually exclusive (e.g., farming vs soil stabilization) and which are complementary or products of joint production (e.g., soil stabilization and maintenance of species). We then apply benefit transfer principles with contingent valuation methodology (CVM), travel cost methodology (TCM), and hedonic damage pricing (HDP). Finally, we derive upper-limit values for more difficult-to-value functions through the use of human analogs, which we argue are the most appropriate method of valuation under some circumstances. The highest values of natural shrub-steppe habitat appear to be derived from soil stabilization.KEY WORDS: Natural resource economics; Ecological economics; Ecological resources; Shrub-steppe; Environmental valuation; Cost; Benefit; Value

Journal Article↗
PubMed1994

Practical knowledge and competencies of the healing role of the nurse practitioner.

This qualitative study describes the practical knowledge and competencies of the healing role of the nurse practitioner. The conceptual framework is based on Benner's (1984) domains of nursing practice and aspects of practical knowledge and Brykczynski's (1985) study of the clinical practice of nurse practitioners. The healing role is described within the context of the healing domain of the National Organization of Nurse Practitioner Faculties' curriculum guidelines (Zimmer et al., 1990) and Benner's aspects of practical knowledge. The study used the interpretive research approach of Heideggerian hermeneutic phenomenology. The findings contribute two maxims that constitute aspects of practical knowledge: "little things mean a lot" and "healing begins with listening," and two additional healing competencies: sensitive humor and risk taking.

Clinical Competence↗
PubMed1996

Assessment of clinical and communication skills: operationalizing Benner's model.

The introduction of ward-based clinical assessment of nursing skills in the 1970s meant a more realistic method of assessment, but still essentially a 'snapshot' of the student's practical abilities. This now being replaced by continuous clinical assessment which requires that student nurses meet the expected level of competence in a range of nursing skills in each clinical placement. Benner's (1984) model of skill acquisition is currently receiving considerable attention by nurse educationalists and is providing the framework for many curricula (English 1993). The model identifies five stages of development in nursing: novice; advanced beginner; competent; proficient; and expert. What is needed, however, is a more detailed description of what those stages mean in terms of the component parts of nursing, especially the clinical and communication skills. This paper describes a framework for the assessment of clinical and communication skills, a framework which seeks to operationalize Benner's model by defining the level of performance expected in clinical and communication skills at each stage.

Clinical Competence↗
PubMed2001

Effects of humanization and gene shuffling on immunogenicity and antigen binding of anti-TAG-72 single-chain Fvs.

One major constraint in the clinical application of murine monoclonal antibodies (MAbs) is the development of a human antimurine antibody response. The immunogenicity of MAbs can be minimized by replacing nonhuman regions with corresponding human sequences. The studies reported in our article were undertaken to analyze the immunoreactivity and the immunogenicity of the CC49 single-chain antibody fragments (scFvs): (i) an scFv construct comprised of mouse CC49 VL and VH (m/m scFv), (ii) a light chain shuffled scFv with human VL (Hum4 VL) and mouse CC49 VH (h/m scFv), and (iii) a humanized scFv assembled from Hum4 VL and CC49 VH complementary determining regions (CDRs) grafted onto a VH framework of MAb 21/28' CL (h/CDR scFv). The CC49 scFvs competed for an antigen binding site with CC49 IgG in a similar fashion in a competition radioimmunoassay and were able to inhibit the binding of CC49 IgG to the antigen completely. The immunogenicity of CC49 scFvs was tested using sera with antiidiotypic antibodies to MAb CC49 obtained from patients treated by CC49 IgG in clinical trials. All tested sera exhibited the highest reactivity to the m/m scFv. However, the sera demonstrated differential reactivities to h/CDR scFv and h/m scFv. Replacement of the mouse chain in h/m scFv and h/CDR scFv decreased or completely averted serum reactivity. Our studies compared for the first time the antigen binding and immunogenicity of different scFv constructs containing the mouse, CDR grafted or human variable chains. These results indicate that the humanized CC49 scFv is potentially an important agent for imaging and therapeutic applications with TAG-72-positive tumors.

Amino Acid Sequence↗
PubMed2004

Ethical issues in HIV.

The number of people with HIV/AIDS continues to increase globally. Women, who represent the subgroup with the fastest rate of increase, are usually informed of their serostatus by the obstetrician/gynaecologist. As treatment of infected women raises a number of ethical issues, an understanding of the theoretical background for ethical decision making is requisite to ensure these problems are resolved within a morally appropriate framework. Vigorous debate has arisen from the tensions between the competing goals of HIV testing, third party disclosure, management of the critically ill HIV-infected woman, infertility management in the background of HIV/AIDS, and gender-based violence as cause or result of acquiring HIV infection. Women may be differently empowered economically, socially and culturally. What may be a satisfactory solution in the context of the USA and Europe may be far from ideal in that of the developing world.

Adult↗
PubMed2004

Multi-criteria decision analysis for the optimal management of nitrate contamination of aquifers.

We present an integrated methodology for the optimal management of nitrate contamination of ground water combining environmental assessment and economic cost evaluation through multi-criteria decision analysis. The proposed methodology incorporates an integrated physical modeling framework accounting for on-ground nitrogen loading and losses, soil nitrogen dynamics, and fate and transport of nitrate in ground water to compute the sustainable on-ground nitrogen loading such that the maximum contaminant level is not violated. A number of protection alternatives to stipulate the predicted sustainable on-ground nitrogen loading are evaluated using the decision analysis that employs the importance order of criteria approach for ranking and selection of the protection alternatives. The methodology was successfully demonstrated for the Sumas-Blaine aquifer in Washington State. The results showed the importance of using this integrated approach which predicts the sustainable on-ground nitrogen loadings and provides an insight into the economic consequences generated in satisfying the environmental constraints. The results also show that the proposed decision analysis framework, within certain limitations, is effective when selecting alternatives with competing demands.

Costs and Cost Analysis↗
PubMed1996

Statistical methods for cost-effectiveness analyses.

A statistical framework is presented for examining cost and effect data on competing interventions obtained from an RCT or from an observational study. Parameters of the join distribution of costs and effects or a regression function linking costs and effects are used to define cost-effectiveness (c-e) measures. Several new c-e measures are proposed that utilize the linkage between costs and effects on the patient level. These measures reflect perspectives that are different from those of the commonly used measures, such as the ratio of expected cost to expected effect, and they can lead to different relative rankings of the interventions. The cost-effectiveness of interventions are assessed statistically in a two stage procedure that first eliminates clearly inferior interventions. Members of the remaining admissible set are then rank ordered according to a c-e preference measure. Statistical techniques, particularly in the multivariate normal case, are given for several commonly used c-e measures. These techniques provide methods for obtaining confidence intervals, for testing the hypothesis of admissibility and for the equality of interventions, and for ranking interventions. The ideas are illustrated for a hypothetical clinical trial of antipsychotic agents for community-based persons with mental illness.

Antipsychotic Agents↗
PubMed1996

Home hemodialysis--yes, it can be learned.

Sacred Heart Kidney Center has maintained a strong home hemodialysis program in Spokane for the past 34 years. Patients who choose this option consistently lead more independent lives, taking more responsibility for their own care. They have the positive attitude that dialysis is a small part of their lives rather than the core of a life dominated by a schedule at a dialysis center. Sacred Heart's home hemodialysis program fosters independence and self-motivation using a stepwise training process for the patient and partner. A skilled training nurse directs the training at the dialysis center. The nurse's work is enhanced by the entire dialysis team, including the nephrologist, social worker, dietitian, and equipment technician. The patient and partner pass through a series of integrated learning blocks, mastering each at their own pace. This method is an effective and efficient way of leading the patient and partner to competence and independence. Training and follow-up provide the framework for supporting day-to-day dialysis in the patient's home and allow for continued multidisciplinary interventions.

Hemodialysis, Home↗