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PubMed1994

King's theory: a critique of the critiques.

This article describes Imogene M. King's conceptual framework and theory of goal attainment. The critiques of various nursing scholars reflect a misunderstanding of the intent of the theory and conceptual framework. Major areas of concern of the critics include cultural limitations, patient competence, and lack of specific guidelines to work within the nursing process. These critiques are discussed and examples supporting the use of King's work in practice are presented.

Goals↗
PubMed1991

Pharmacists and the mandate of pharmaceutical care.

Implementing the mandate for delivery of drug therapy to achieve definite outcomes that improve a patient's quality of life is discussed from the perspective of the changes currently needed in both practice and education. Specifically, changes in practice should include: (1) a managerial framework that continuously supports clinical activities in everyday practice, (2) recognition of competence in clinical practice, and (3) documentation of and reimbursement for clinical service. Changes in education should include: (1) teaching of problem-solving skills to students by faculty/practitioners, and (2) redirecting the curricular content to provide the minimum knowledge base required for competent clinical practice. Pharmacists will begin to accept the mandate of pharmaceutical care when there is widespread training and use of technicians, implementation of problem-based education in the schools, and adequate problem-solving support for pharmacists in practice.

Drug Therapy↗
PubMed1989

Ethics in obstetric ultrasound.

The authors provide an overview of ethics, medical ethics, and obstetric ethics. An ethical framework is developed using the beneficence and autonomy models of moral responsibility in obstetric care. In terms of this framework, four ethical issues common to all ultrasound examinations are examined: (1) competence to perform obstetric ultrasound and referral to specialists, (2) routine ultrasound screening, (3) disclosure of results, and (4) confidentiality.

Beneficence↗
PubMed1976

[Timing of the orthodontic treatment in patients with cleft lip and cleft palate].

There is now a general concensus of opinion that the specific care of patients with congenital clefts should be performed in the framework of their rehabilitation in large centres. The values of timely and competent care is deduced from results obtained from 100 orthodontic patients. In cleft patients orthodontic treatment must begin several years earlier than in patients without clefts.

Age Factors↗
PubMed1992

[Assessment of IDF physicians in in-field trauma].

The system of care delivery of in-field trauma was assessed, leading to suggestions for improving the system and military medical training. This study reports the feasibility and validity of various methods of assessing the performance of Israel Defense Force physicians in administering trauma care. The methods included a standardized medical debriefing with filling in of a report form by a senior traumatologist, his review of the physician's performance, self-assessment by the physician, and a written test. 5 senior traumatologists with extensive experience in military trauma care were trained to assess the physicians' performance within 24-48 hours of incidents involving moderate to severe trauma injuries. 75 physicians who had been involved in the care of the in-field trauma patients during a 1-year period, November 1988 to October 1989, were assessed. Analysis of the results clearly indicated 2 areas for assessment: a) knowledge, mainly levels of comprehension and application in relevant areas of trauma and b) performance, including immediate diagnosis, treatment skills, and triage. The best method for evaluating knowledge was the written test, not peer review nor self-evaluation. However, the traumatologist's evaluation of care performance was highly correlated with the physician's self-assessment. For comprehensive assessment of in-field care it is advisable to integrate the 2 methods: performance review by a traumatologist and a comprehensive written test. Information gained from such assessment could improve the planning of in-service trauma training and the posting of physicians within the military framework.

Clinical Competence↗
PubMedDate not supplied

Nurse practitioner research: selected literature review and research agenda.

Selected literature is reviewed to illustrate current conceptual and methodological issues in nurse practitioner research. Concepts of style of practice, acceptance, satisfaction, and outcome are discussed. Methodological issues are linking process to outcome, complexity measures, use of existing data, and the effect of nurse practitioner education and experience on interpretation of findings. A research agenda with two objectives is proposed: studies designed to improve rather than evaluate practice and studies designed with a policy framework in mind.

Clinical Competence↗
PubMedDate not supplied

Decision-making in A&E by expert nurses.

The A&E service at Manchester Royal Eye Hospital uses triage as a method of prioritising patients to ensure that those whose needs are urgent receive immediate attention. The service has been extended to include formalised telephone triage. This study investigates the way in which telephone triage decisions are made by nurse practitioners in A&E. Although the sample is small, interviews with nurse practitioners reinforce previous theories about expert knowledge and decision-making. The practitioners use a process of hypothesis testing and a systematic and complex framework for decision-making.

Clinical Competence↗
PubMed2000

Critical thinking and nursing scripts: the case for the development of both.

It is argued that contemporary nursing education's emphasis on the conscious development of nurses' critical reasoning skills fails to take account of the complexity of both human cognition and clinical nursing practice. Human cognition centrally includes unconscious or tacit processes and clinical nursing practice is typified by the simultaneous presentation of clinical and non-clinical cues and competing clinical goals. Contemporary emphases on conscious critical thinking are largely consistent with the differing theoretical frameworks which have informed the study of nurses' clinical reasoning in the last 30 years, most of which permit the use of simulated case study. These frameworks, that is, decision theory, information processing and skills acquisition theory, are described and their limitations highlighted. In addition, an alternative theoretical framework, that of schema or script theory, which does take account of the complexities of cognition and practice, is discussed. Its implications for nursing practice and education are also outlined.

Clinical Competence↗
PubMed2005

Competency versus hours: an examination of a current dilemma in nurse education.

In Europe student nurses have to work within a framework of curriculum hours, the regulations governing which were determined almost three decades ago. European Higher Education institutions involved in the delivery of nurse education are constrained by this European Union legislation that harks back to an era of apprenticeship rather than modern day educational approaches. This article describes the background to current educational practices and discusses the conflict between legal requirements, enshrined in professional regulations and the realities of competency driven educational philosophy.

Clinical Competence↗
PubMed2005

Forensic psychiatry fellowship training: developmental stages as an educational framework.

As an official subspecialty of psychiatry, forensic psychiatry residency training must meet the requirements established by the Accreditation Council of Graduate Medical Education. Attendant to these requirements is the expectation that graduates demonstrate core competencies in general areas common to all medical training programs but delineated for each specialty. In forensic psychiatry, trainees must learn to move from the role of healer to objective evaluator on behalf of third parties, a task that differs from general medical care and treatment. Thus, it is important for educators to maintain awareness of the experience of trainees as they adapt to forensic psychiatry, while understanding core competency requirements. This article outlines stages of development of forensic psychiatry fellows as a model for characterizing learning objectives and for supervising trainees in forensic psychiatry fellowship programs. These stages of development include (1) transformation, (2) growth of confidence and adaptation, and (3) identification and realization. Training directors and trainees can utilize this theoretical framework as a basis on which to establish parameters for core competency attainment and supervisory and assessment methods for forensic psychiatry training.

Achievement↗
PubMed2026

Identifying stakeholder behaviors for competency-based pharmacy education: A stage 1 behavior change wheel analysis.

INTRODUCTION/OBJECTIVES: Competency-Based Pharmacy Education (CBPE) is a strategic priority for preparing graduates to meet evolving healthcare needs. However, efforts to implement CBPE can stall due to behavioral challenges among faculty, administrators, preceptors, and learners. This study aimed to apply Stage 1 of the Behavior Change Wheel (BCW) to identify stakeholder-specific behaviors and associated determinants needed to implement the five core components of CBPE. METHODS: A multi-method approach grounded in the BCW, the Capability, Opportunity, Motivation - Behavior (COM-B) model, and the Theoretical Domains Framework (TDF) was used. Data were gathered through (1) targeted literature review; (2) structured focus groups with competency-based education experts and pharmacy education stakeholders; and (3) an iterative consensus process. Behaviors were mapped to the five CBPE components: (1) defined competencies, (2) developmental progression, (3) tailored instruction, (4) authentic experiential learning, and (5) programmatic assessment, and then mapped to COM-B and TDF constructs. RESULTS: Over fifty stakeholder-specific behaviors were identified and specified across the CBPE framework. This revealed shared barriers such as limited instructional design knowledge (psychological capability), insufficient assessment of infrastructure (physical opportunity), and misaligned professional identity (reflective motivation). Key TDF domains included knowledge, environmental context, beliefs about capabilities, and professional roles. The behavioral problem statements, specifications, and determinants were identified to support future intervention planning. CONCLUSION: This Stage 1 analysis provides a behaviorally grounded foundation for CBPE implementation by identifying stakeholder behaviors and conditions that enable change. These findings will inform the development of readiness-to-change assessments and targeted interventions (BCW Stages 2 and 3), supporting scalable and sustainable CBPE transformation in pharmacy education.

Education, Pharmacy↗
PubMed2006

Resource partitioning among savanna grazers mediated by local heterogeneity: an experimental approach.

Recent theoretical studies predict that body size-related interspecific differences in spatial scale of perception and resource use may contribute to coexistence of species that compete for the same class of resources. These studies provide a new theoretical framework for explaining resource partitioning patterns among African ungulates that coexist in spatially heterogeneous savanna grasslands. According to these studies, different-sized ungulates can coexist because larger species forage at a coarser scale but can tolerate lower quality food, whereas smaller species need higher quality food but forage at a finer scale. To test this hypothesis in an African savanna, we created an experimental mosaic with variation in grain (spatial detail) and quality of short-grass patches and directly observed the visitation of naturally occurring grazers to this mosaic over a two-year period (total of 903 observation hours). Of the seven species that visited our experiment, warthog, impala, zebra, and white rhino visited long enough to allow data analysis. We showed that warthog and impala avoided plots with a finer grain of short grass and that warthog preferred fertilized plots to unfertilized plots. Zebra and white rhino did not avoid the finer grain plots. Our results suggest that differences in grain and quality of a resource might indeed contribute to partitioning of this resource by savanna ungulates. Although four focal species is unusually high for an experimental study on resource partitioning among naturally occurring savanna ungulates, this number is too low to evaluate the allometric basis of our hypothesis. Our results, however, encourage wider experimental testing of the role of spatial heterogeneity in facilitating the coexistence of potentially competing savanna herbivores.

Animals↗
PubMed1987

[Evolution of the communicative function].

This presentation of recent developments in child language research attempts to show that communicative competence is not built solely upon purely linguistic foundations. The development of communicative competence cannot be considered to begin with the first words. There is a growing body of evidence showing that functional communication appears long before the child's first uses of meaning-bearing sound sequences based on the adult language. Adult-child interaction, both during prelinguistic and early linguistic stages, provides an essential framework upon which verbal communication is based. The acquisition of what can be considered as pragmatic competence, necessary for all communication, begins from the birth.

Child, Preschool↗
PubMed1989

[Rehabilitation and the European Community internal market].

Given the limited competencies of the European Community (EC) in this respect, harmonization of rehabilitation at the level and within the framework of the EC is not expected to occur in the foreseeable future even after completion of the EC internal market. There will however be increased efforts to coordinate existing systems. Moreover, decisions and measures in other fields, with broader competencies on the part of the EC, may affect the field of integration of disabled persons (e.g., transportation, vocational education). In the same manner, the harmonization of technical standards applicable for medical equipment may influence the field of rehabilitation. If, after completion of the internal market, rehabilitative services were sought abroad in countries of the EC, refusal to accept the costs incurred on territorial grounds alone would not seem to be considered admissible any longer.

Persons with Disabilities↗
PubMed1995

[Competence in nursing and its significance for professionalization].

The occupation of nursing is in an advanced stage of change. Demands for autonomy are manifest in the attempt to make nursing scientific. This results in raising the question, among others, of defining what it is about competence which makes it possible to call nursing a profession. Looking at developmental models, at the theory of socialisation one finds, typical of professions, congruence of head, heart and hand (cognitive, moral-communicative and pragmatic competence). An attempt is made to demonstrate that moral competence has the most important place because justice and caring form the nucleus of nursing models, within a framework of advocatorial ethics. Nursing loses its purpose if it is dominated by rationale of outcome and by the pragmatism of routine action. Professionalisation of nursing can make progress if research can provide valid arguments for autonomy, based on the competence paradigm described here.

Ethics, Nursing↗
PubMed1999

Curriculum renewal and a process of care curriculum for teaching clerkship students.

BACKGROUND AND OBJECTIVES: A school-wide curriculum renewal led to a new clerkship curriculum that teaches core family practice competencies by focusing on the process of care in generalist practice. The organizing framework consists of five prototypic visits and their encounter tasks: 1) new problem visit, 2) checkup visit, 3) chronic illness visit, 4) psychosocial problem visit, and 5) behavioral change visit. METHODS: The seminars occur at the beginning of the rotation and use active learning techniques. Evaluation includes student perceptions of the seminars and teachers and student performance on a clinical performance examination (CPX). RESULTS: Students rated the usefulness of the seminars and the seminar leaders' teaching behaviors favorably. The CPX checklist scores showed that students could perform most of the behaviors expected for each prototypic visit. The students listed the appropriate encounter tasks nearly half of the time when describing what tasks they tried to accomplish during the CPX cases. The students listed concrete behaviors just over 50% of the time. CONCLUSIONS: The students learned the material presented in the seminars and applied it during the CPX. Students can do most of the behaviors but do not seem to describe the tasks as abstractly as faculty. These results come from one class cohort in one medical school, so the generalizability is limited until further work, including other learners, confirms these findings.

Attitude of Health Personnel↗
PubMedDate not supplied

Creating corporate advantage.

What differentiates truly great corporate strategies from the merely adequate? How can executives at the corporate level create tangible advantage for their businesses that makes the whole more than the sum of the parts? This article presents a comprehensive framework for value creation in the multibusiness company. It addresses the most fundamental questions of corporate strategy: What businesses should a company be in? How should it coordinate activities across businesses? What role should the corporate office play? How should the corporation measure and control performance? Through detailed case studies of Tyco International, Sharp, the Newell Company, and Saatchi and Saatchi, the authors demonstrate that the answers to all those questions are driven largely by the nature of a company's special resources--its assets, skills, and capabilities. These range along a continuum from the highly specialized at one end to the very general at the other. A corporation's location on the continuum constrains the set of businesses it should compete in and limits its choices about the design of its organization. Applying the framework, the authors point out the common mistakes that result from misaligned corporate strategies. Companies mistakenly enter businesses based on similarities in products rather than the resources that contribute to competitive advantage in each business. Instead of tailoring organizational structures and systems to the needs of a particular strategy, they create plain-vanilla corporate offices and infrastructures. The company examples demonstrate that one size does not fit all. One can find great corporate strategies all along the continuum.

Commerce↗