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PubMedDate not supplied

Analysis of end-of-life content in critical care nursing textbooks.

Nurses have identified a need for improving their knowledge and skills in providing end-of-life care. Critical care nursing textbooks can serve as an important source of information on end-of-life care for critical care nurses. Hence, an analysis of end-of-life content in 14 critical care nursing textbooks was conducted. Critical care nursing textbooks used for review were published in 1995 or later and identified from the libraries at the University of Wisconsin-Madison and Brigham Young University. The end-of-life content areas identified by the American Association of Colleges of Nursing (AACN), under which the AACN end-of-life competencies for undergraduate nursing students can be taught, were used as a framework for assessing the presence or absence of end-of-life content in the textbooks. When end-of-life content was present, two reviewers judged whether the information was helpful. Four additional end-of-life content areas were identified in some textbooks during the study, and reviewers also judged whether these were helpful. None of the textbooks had end-of-life content in all the content areas used for the analysis. Three textbooks did not contain any end-of-life content.

Attitude of Health Personnel↗
PubMedDate not supplied

The patient care process: a framework for change.

Healthcare organizations across the United States recognize that they must change the way in which they deliver case. As organizations reengineer to reduce costs and change the way in which services are delivered, it is critical that decisions about reengineering be communicated throughout the entire service-delivery enterprise. There must be a framework to provide a common ground for change. The process approach to delivering service provides the greatest opportunity for organizations to achieve their goals to facilitate care, achieve the best patient outcomes, and deliver services on time and at the right price. Processes that are built around core competencies and that address customer needs are the most successful. Organizations that adopt a common framework built around the delivery of patient care and the patient care process can establish a common frame of reference for the entire organization and therefore can enhance the delivery of service for their patients and achieve organization-wide commitment to common goals.

Case Management↗
PubMed1995

Using knowledge maintenance for preference assessment.

Most real-life decisions require the decision maker to make trade-offs in order to fulfill multiple conflicting objectives. This is especially true in medical decision making while selecting the optimal therapy plan from among competing therapy plans for a patient. Multi-attribute utility theory provides a framework to specify these trade-offs for optimal decision making based on the preferences of the decision maker. However traditional preference-assessment techniques are difficult to implement and rarely elicit the true preferences of the decision maker. We describe a new preference-assessment method based on the concept of knowledge maintenance where the preference model is changed each time it makes an incorrect recommendation. The method is implemented in a decision-theoretic system to evaluate competing three-dimensional radiation treatment plans. The preference-assessment method leads to preference models which perform better than preference models elicited using traditional assessment techniques.

Abdominal Neoplasms↗
PubMed2004

Consent and confusion--who decides?

Current trends in the NHS promote patient rights including the right to accept or refuse surgery. Valid consent when the patient appears to have fluctuating competence can place theatre nurses in a difficult position. This article explores the legal framework in which the Department of Health consent forms work and looks at the NMC's Code of Professional Conduct for standards of practice.

Adolescent↗
PubMed1991

Court-ordered treatment in obstetrics: the ethical views and legal framework.

Four main ethical views have been put forward concerning court-ordered treatment of mentally competent pregnant women for fetal indications: 1) Such treatment is never justifiable; 2) it is justifiable provided it poses no health risks for the woman, minimally invades her bodily integrity, and would clearly prevent substantial harm to the fetus; 3) it is justifiable provided the maternal risks are low, there is a substantial likelihood that the fetus will suffer irrevocable harm without the intervention, and the treatment will likely be effective; and 4) it is justifiable provided the risks to the woman are ones she should reasonably accept, the fetal risks of treatment are minimal, and the potential fetal benefit is substantial. However, the first two views are too rigid to adequately handle the variety of clinical situations in which maternal treatment refusal can occur, and recent legal decisions have ruled out the other views. The ethics of court-ordered treatment are often discussed as though the only interests involved are those of the pregnant woman and fetus, but other important interests may be relevant. An ethical view that avoids these difficulties and takes better account of the complexity of the issues is as follows: Such treatment is justifiable in rare, exceptional circumstances provided it poses insignificant or no health risks to the woman or would promote her interests in life or health and there are compelling reasons to override her autonomy.

Ethics, Medical↗
PubMed2003

Self-perceived competence, learning conceptions and preferred learning situations in the domain of communication.

BACKGROUND: An important purpose of education in the field of social work is the development of social-communicative competence and students' individual learning theories (ILTs) concerning this domain. AIMS: Our first aim was to develop diagnostic instruments for ILT assessment and to understand the relationships between ILT variables. Our second purpose was to study the differences in ILT variables between students of three study years. SAMPLES: A total of 396 full-time social work students participated in this study: 176 first-year, 147 second-year and 73 fourth-year students (92% women and 8% men). METHOD: Based on a theoretical framework, three questionnaires have been constructed, covering three ILT variables: self-perceived competence, learning conceptions and preferred learning situations. For scale construction, principal component analyses and reliability analyses were conducted. ANOVAs and post hoc comparisons of means were used to investigate cross-sectional differences regarding ILT variables. Pearson correlations and regression analyses were performed to gain more insight into the relationships between ILT variables. RESULTS: Five aspects of self-perceived competence, four learning conceptions and five preferred learning situations were found. Learning conceptions and self-perceived competencies were found to be predictors of students' preferred learning situations. Many differences were found between the three groups of students, especially between the first-year students and the others. CONCLUSIONS: When studying the acquisition of social-communicative competence, it is important to take students' individual learning theories into account. Increased insight into the role ILTs play can be of help in improving social work education.

Choice Behavior↗
PubMed2002

Concept mapping: a tool to bridge the disciplinary divide.

The American College of Women's Health Physicians has been exploring an on-line educational tool-concept mapping-to facilitate the development of an interdisciplinary and woman-centered women's health curriculum, and to implement The Women's Health Care Competencies for Medical Students. By using an on-line concept map of the menstrual cycle, we have built upon a standard piece of curricula that describes a unique aspect of female physiology and transformed it into a knowledge framework that builds capacity. The concept map highlights relationships between concepts and across disciplines, connecting the competencies to enable meaningful learning so that a learner can adapt their knowledge to multiple settings, incorporate new learning, and generate new knowledge to grow the interdisciplinary field of women's health. The on-line format allows access from multiple sites and courses, and allows the curricula to grow organically over time without upsetting current curricular design.

Artificial Intelligence↗
PubMed1999

Incidence and duration of hospitalizations among persons with AIDS: an event history approach.

OBJECTIVE: To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES: PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified through Medicaid claims. STUDY DESIGN: Using a Weibull event history framework, we model the hazard of transition between hospitalized and community spells, incorporating the competing risk of death in each of these states. Simulations are used to translate these parameters into readily interpretable estimates of length of stay, the probability that a hospitalization will end in death, and the probability that a nonhospitalized person will be hospitalized within 90 days. PRINCIPAL FINDINGS: In multivariate analyses, participation in a Medicaid waiver program offering case management and home care was associated with hospital stays 1.3 days shorter than for nonparticipants. African American race and Hispanic ethnicity were associated with hospital stays 1.2 days and 1.0 day longer than for non-Hispanic whites; African Americans also experienced more frequent hospital admissions. Residents of the high-HIV-prevalence area of the state had more frequent admissions and stays two days longer than those residing elsewhere in the state. Older PWAs experienced less frequent hospital admissions but longer stays, with hospitalizations of 55-year-olds lasting 8.25 days longer than those of 25-year-olds. CONCLUSIONS: Much socioeconomic and geographic variability exists both in the incidence and in the duration of hospitalization among persons with AIDS in New Jersey. Event history analysis provides a useful statistical framework for analysis of these variations, deals appropriately with data in which duration of observation varies from individual to individual, and permits the competing risk of death to be incorporated into the model. Transition models of this type have broad applicability in modeling the risk and duration of hospitalization in chronic illnesses.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Legal implications of task rearrangement for nurses in the Netherlands.

The central question in this article concerns the implications of developments in the rearrangement of tasks in health care, particularly for nurses in terms of their duties and responsibilities. Attention is focused on the transfer of medical tasks from physicians to nurses. An investigation was carried out on the impact of the rearrangement of tasks from the perspective of health care law on the legal framework of the nursing profession. From case law it can be concluded that a number of specific conditions have to be met, such as mentoring, supervision and audit, orders and instructions, clear agreement about task allocation, comparing information, and making certain that the person who is given the instruction is sufficiently competent and experienced to carry it out. Although the rearrangement of tasks fits into the existing legal framework, changes in the health professions have to be met more flexibly.

Clinical Competence↗
PubMed2026

Identifying General Practitioners, Nurses, and Pharmacists Training Needs in Precision Medicine: A Survey Study.

INTRODUCTION: The clinical advances of precision medicine, elevating clinical decision-making through use of genetic and genomic data, lifestyle, and environment factors, is improving patient outcomes. Health care professionals report they are not competent or confident to deliver precision medicine to patients. To design continuing education for advanced practice nurses, general practitioners, and pharmacists, this research investigates perceived knowledge, importance, and self-efficacy in precision medicine. METHODS: Items were informed from results of a literature review and focus group study. A one-sample t test was used to compare differences for each item toward the theoretical neutral value (indifferent in our case, to number 3). To analyze differences between professions, parametric analyses of variance (ANOVA) was used. RESULTS: A lack of time, further complicated by a lack of knowledge about precision medicine services, and how to safely share patient data, with a perceived limited network of professionals in precision medicine were reported. Respondents demonstrated low confidence in precision medicine topics while indicating a willingness to pursue training aimed at improving their genetic and genomic competencies. Participants rated topics as only slightly important to their current professional roles. No significant differences were found across professional groups. DISCUSSION: Flexible formats for continuing education aligned to needs are required to target the knowledge and skills gap in precision medicine. Improved knowledge on topics including ethics, legal frameworks, and precision services is needed. Effective educational interventions aimed at enhancing the confidence and competence of health care professionals are essential to making precision care a reality for patients.

CPD↗
PubMed2004

Mandatory reflection: the Canadian reconstitution of the competent nurse.

Over the past two decades, the competency movement has been gathering momentum internationally within the ranks of professional nursing. It can be argued that this momentum is in response to government initiatives aimed at improving consistency in workforce training and accreditation, and fostering national and international portability of qualifications. At the same time, the competency movement has provided the opportunity for regulators, service providers and government to develop mechanisms to reconstitute competent nurses as accountable, self-regulating subjects and to monitor this transformation in particular ways. The ways in which competencies have been taken up to do this transforming work in Canada are unique and deserving of some detailed description and analysis. We argue that Canadian nursing regulatory authorities have chosen to view competence as the rehearsal of ethical attributes consonant with the professional role, as opposed to the enactment of skilled conduct. As a result, reflective practices rather than skill and knowledge have become the cornerstone of nursing competency formulation and review. We argue that this distinctly Canadian approach to competency serves three ends. First, it privileges the "attribute" element of the nursing competency model and side steps the ever-problematic "nursing knowledge" issue; second, self-surveillance by nurses shifts the onus for professional development from industry to the individual; and third, it concedes responsibility for skill assessment by the regulatory authorities to industry control, leaving employers free to determine skill base and skill mix requirements for practice. Finally, we argue that the reflective component of the regulatory framework for Canadian nurses radically fails as a tool for auditing quality and assessing competency. Rather, it functions as a governmental practice that furthers the deregulatory and economic rationalist aims of the Canadian health reform agenda.

Attitude of Health Personnel↗
PubMed2003

A framework for consciousness.

Here we summarize our present approach to the problem of consciousness. After an introduction outlining our general strategy, we describe what is meant by the term 'framework' and set it out under ten headings. This framework offers a coherent scheme for explaining the neural correlates of (visual) consciousness in terms of competing cellular assemblies. Most of the ideas we favor have been suggested before, but their combination is original. We also outline some general experimental approaches to the problem and, finally, acknowledge some relevant aspects of the brain that have been left out of the proposed framework.

Action Potentials↗
PubMed2004

Defining generic objectives for community-based education in undergraduate medical programmes.

RATIONALE: The availability of a framework for the definition of generic objectives for community-based education (CBE) programmes may assist in the rational design of objectives for specific CBE programmes. STRATEGY: Factors impacting on community health from the perspective of a developing country were collected. Potential assistance from medical students to communities to improve their health status was determined. Competencies required in students to execute tasks in the community were defined and eventually educational objectives to develop these competencies in the students were established. METHODS: Factors impacting on community health and activities of medical students in CBE programmes were identified by review of literature and Internet resources. Competencies desired for execution of tasks by students and educational objectives to develop these competencies were defined by us and checked against pertinent literature. A draft table representing the 4 elements of the framework was discussed by an international group of experts for external validation. MAIN OUTCOMES: A total of 26 factors impacting on community health were identified and clustered in 5 domains. Twenty-one generic objectives for CBE programmes were defined to develop the required competencies in students. Analogues of each of these 21 objectives were found in at least 1 publication specifying objectives for specific CBE programmes but none of these publications stated any objective not covered by our list of generic objectives. CONCLUSION: It proved possible to develop a framework to define generic objectives for CBE programmes. An example was elaborated from the perspective of a medical school in a developing country.

Clinical Competence↗
PubMedDate not supplied

Aging in mammalian cell population: a review.

Research on in vitro aging and development is reviewed within a framework provided by three aspects of population growth--birth, canalization and death. Although there are periodic changes in the birth rate coupled to periodic changes in the in vitro environment, there do not appear to be any age-related changes in the birth rate of dividing cells. There appear to be distinct subpopulations of dividing and nondividing cells, each with its own characteristic morphological and functional properties; thus, Weiss-Kavanaugh theory may be applicable to the growth, maturation and senescence of mammalian cell populations. Substantial cell losses occur during subcultivation and transfer; correction for these losses requires substantial reinterpretation of existing experimental findings. The various measures of age are poorly correlated with one another; there is wide variation from population to population. A uniform measure of age has been found in the cell generation, the number of ancestors of a given cell. Studies of intrinsic variation in development can provide additional insight into the developmental process. The framework of birth, canalization and death permits reduction in the number of competing hypotheses of aging in mammalian cell populations. Additional experimental evidence is needed to discriminate among the remaining hypotheses.

Aging↗
PubMed1989

Reviving the superorganism.

Individuals become functionally organized to survive and reproduce in their environments by the process of natural selection. The question of whether larger units such as groups and communities can possess similar properties of functional organization, and therefore be regarded as "superorganisms", has a long history in biological thought. Modern evolutionary biology has rejected the concept of superorganisms, explaining virtually all adaptations at the individual or gene level. We criticize the modern literature on three counts. First, individual selection in its strong form is founded on a logical contradiction, in which genes-in-individuals are treated differently than individuals-in-groups or species-in-communities. Imposing consistency clearly shows that groups and communities can be organisms in the same sense that individuals are. Furthermore, superorganisms are more than just a theoretical possibility and actually exist in nature. Second, the view that genes are the "ultimate" unit of selection is irrelevant to the question of functional organization. Third, modern evolutionary biology includes numerous conceptual frameworks for analyzing evolution in structured populations. These frameworks should be regarded as different ways of analyzing a common process which, to be correct, must converge on the same conclusions. Unfortunately, evolutionists frequently regard them as competing theories that invoke different mechanisms, such that if one is "right" the others must be "wrong". The problem of multiple frameworks is aggravated by the fact that major terms, such as "units of selection", are defined differently within each framework, yet many evolutionists who use one framework to argue against another assume shared meanings. We suggest that focusing on the concept of organism will help dispell this fog of semantic confusion, allowing all frameworks to converge on the same conclusions regarding units of functional organization.

Animals↗
PubMed1999

The nurse lecturer role in clinical practice conceptualized: helping clinical teachers provide optimal student learning.

Despite the fairly wide reporting in the literature of the many roles of clinical supervision by the nursing teacher, little attention has been given to conceptualizing the relative priorities these roles take during the process of supervising nursing students in clinical practice. The purpose of this paper is to consider the manifestations and implications of conflicting roles when nurse lecturers undertake clinical supervision. Previously published research will provide working examples of issues in a conceptual framework for clinical teaching.

Clinical Competence↗
PubMed2006

Canid immunity to Echinococcus spp.: impact on transmission.

The canid intestinal immune system recognizes the cestode parasite Echinococcus following infection, but it is still unclear the extent to which protection against reinfection occurs. An increasing number of studies have shown that there are convex age-related abundance or prevalence rates in naturally infected populations of dogs with E. granulosus and foxes infected with E. multilocularis. Data from dogs naturally infected with E. granulosus give a better fit to a model that incorporates herd immunity compared to competing models of age-related changes in infection pressure. A theoretical framework suggests that such herd immunity will act as a stabilizing force for Echinococcus populations. Hence a decrease in infection pressure to dogs or foxes will not result in a corresponding decrease in infection pressure to intermediate hosts or to humans. In addition the age structure of the canid population could affect transmission.

Animals↗