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PubMed1998

Eight 'Cs' of caring: a holistic framework for nursing terminally ill patients.

This introductory paper describes how nurses can incorporate eight caring elements into nursing care for terminally ill patients. These caring elements can be described as: Compassion, Competence, Confidence, Conscience, Commitment, Courage, Culture and Communication. The Eight Cs of caring are comprised of Simone Roach's five Cs plus three further Cs. According to Roach (1993), who developed the Five Cs (Compassion, Competence, Confidence, Conscience and Commitment), knowledge, skills and experience make caring unique. Here, I extend Roach's work by proposing three further Cs (Courage, Culture and Communication). The paper takes as its framework the concept of holistic care, which encompasses physical, psychological, emotional, spiritual and cultural aspects. Examples are provided as to how the Eight Cs may be applied. Literature from various nursing scholars is included to support the discussion throughout.

Aged↗

PubMed2003

History and evolution of a successful certification program in nutrition support: the CNSD experience.

As early as the 1970s, articles were published on the role of dietitians in nutrition support. Both the American Society for Parenteral and Enteral Nutrition and The American Dietetic Association addressed the issues of specialization and certification. Development of a specialty area credential requires a strong demand by practicing clinicians, a unique area of clinical practice with a distinct body of knowledge and the commitment to evolve with clinical practice. Numerous dietitians were involved in the inception, development, and leadership that brought forth certification in nutrition support. This article documents the efforts and participation of a dedicated group of professionals whose common goals resulted in the establishment of a successful, sustaining certification in a specialty area of clinical dietetics: certified nutrition support dietitian. The certified nutrition support dietitian program is now in its 15th year with 2,000 dietitians currently certified both nationally and internationally. A primary focus of the credential is to recognize minimum competency for dietitians practicing in the field of enteral and parenteral nutrition and to provide safe and effective nutrition support therapy. This article provides a framework for persons in other specialty areas attempting to develop certification programs.

Certification↗

PubMed1991

Problems of competence-based nurse education.

The system of nurse education in the UK is undergoing a radical shake-up. Many new courses are being designed and implemented along the lines of the Project 2000 framework. New curricula and course structures are required to meet the changing role of the nurse of the future. Many curriculum design teams are adopting a competence-based model of curriculum to meet these needs. This approach is receiving central encouragement (UKCC 1986). In this paper it is argued that this strategy is faulty and ill-conceived; the inherent difficulties of the competence-based model of curriculum design are highlighted. These issues are of fundamental concern to nurse educators and students in the UK.

Clinical Competence↗

PubMedDate not supplied

Home infusion therapy: essential characteristics of a successful education process: grounded theory study.

Little research has been published on the education process from the perspective of family caregivers. This article reports the findings from a grounded theory study of caregivers who successfully learned how to deliver home infusion therapy for a family member. The participant sample was drawn from the home infusion service of a metropolitan health maintenance organization in the western United States. The objective of the study was to identify, from the caregiver's point of view, the characteristics of an education process that resulted in the learner's competence with home infusion therapy. The knowledge gained from this study can be used to develop a framework for examining and planning practice guidelines that reflect the expertise of the nurse and the experiences of the learner.

Adult↗

PubMed2002

Professional development in undergraduate medical curricula--the key to the door of a new culture?

CONTEXT: One of the most pressing requirements for contemporary medical education is to develop a framework for theory and practice of professional development which results in the attainment of professional competencies suitably robust for a lifetime's practice. The proposed content of a professional development curriculum may be reasonably straightforward to establish from policy documents and public expectations, but the process of achieving the desired outcomes is more complex, because professional development is largely based on attitudinal learning. Attitudes are at the interface between the personal and public psyche, relying more on individual experience and the accumulated impact of social and cultural interpretations than on propositional knowledge, and are therefore less amenable to factual or didactic teaching. AIMS: The purpose of this discussion paper is to develop thinking on the conceptual frameworks which need to underpin curriculum decision-making for professional development, especially in undergraduate medical training where models of good practice are less well-established. It brings together work from educational, sociological and psychological perspectives to elucidate the key principles which are most likely to result in acquisition of desirable professional attributes. IMPLICATIONS: The literature suggests that successful professional development needs to be based on explicit values, which are repeatedly demonstrated in the learning environment, and modelled by senior colleagues and tutors; that the curriculum should incorporate a clear model of emotional as well as cognitive development; should be a major component of summative assessment; and needs to include formative mentorship at all stages of training.

Curriculum↗

PubMed1999

Holistic care in the critical care setting: application of a concept through Watson's and Orem's theories of nursing.

For the critical care nurse, two concerns increase the complexity of competent nursing care. First, the intrusion of technology into the critical care environment is more conducive to the use of the medical model than to a nursing theoretical framework. Technology has quantified body functions that were once elusive to man, enabling practitioners to treat dysfunction and disease. Technology, which has provided health care equipment that can maintain breathing, circulation and other important quantifiers of life, is welcomed by a society that fears finality. Second, the critical care nurse must remain cognizant that technology cannot care for the whole being who is in a health care crisis. Holistic caring, the being-with, the empathy, the interconnected experience of need and response within a nursing theoretical framework is the nurse's art. It is this art of caring that is the qualifier of life. It is the balance of technological competency with the art of nursing that promotes adaptations in health crises. Application of holistic caring through established nursing theories such as Watson's theory of nursing and Orem's theory of nursing enable the critical care nurse to acquire an expert level of nursing care.

Clinical Competence↗

PubMedDate not supplied

A review of a supervised practice programme for overseas nurses.

The study described in this article aimed to explore the experiences of internationally recruited nurses (IRNs) and their mentors during a supervised practice programme, using interviews and responses to a questionnaire survey. It also aimed to determine the factors that influence the time it takes IRNs to achieve NMC competencies. The findings strongly suggest that most participants found the supervised practice programme to be a beneficial and supportive framework. However, the findings are limited because of small sample size and low response rates, and further research is indicated.

Attitude of Health Personnel↗

PubMed2003

Clinical supervision - factors defined by nurses as influential upon the development of competence and skills in supervision.

The aim of this study was to describe factors defined by nurses as influential upon the development of competence and skills in supervision. Although clinical supervision has been widely studied and described during the last decade, influential factors regarding the development of supervisory competence, as defined by clinical supervisors themselves, is little documented. Focus group interviews were analysed using methods of qualitative content analysis as described by Kvale. Factors related to three areas of importance for the development of competence and skills in student supervision are defined by nurses in this study. They are didactics, role functions and organizational framework. Didactic factors described included: integration of theory and practice; reflection on clinical situations; clarification of supervision aims and student evaluation. Role function factors were described as: feelings of security and awareness in supervision, differentiation between student and supervisor roles and the meaning attached to being a role model. Framework factors included nursing faculty and clinical field expectations. An understanding of how nurses describe what they need to support their development as clinical supervisors gives a basis for the development of postgraduate education in clinical supervision. Competent clinical supervisors can be better able to support students as they build bridges between theory and practice.

Attitude of Health Personnel↗

PubMed2003

Life history theory and the immune system: steps toward a human ecological immunology.

Within anthropology and human biology, there is growing interest in immune function and its importance to the ecology of human health and development. Biomedical research currently dominates our understanding of immunology, and this paper seeks to highlight the potential contribution of a population-based, ecological approach to the study of human immune function. Concepts from life-history theory are applied to highlight the major challenges and demands that are likely to shape immune function in a range of ecological contexts. Immune function is a major component of maintenance effort, and since resources are limited, trade-offs are expected between investment in maintenance and other critical life-history functions involving growth and reproduction. An adaptationist, life-history perspective helps make sense of the unusual developmental trajectory of immune tissues, and emphasizes that this complex system is designed to incorporate information from the surrounding ecology to guide its development. As a result, there is substantial population variation in immune development and function that is not considered by current biomedical approaches. In an attempt to construct a framework for understanding this variation, immune development is considered in relation to the competing life-history demands that define gestation, infancy, childhood, adolescence, and adulthood. Each life stage poses a unique set of adaptive challenges, and a series of hypotheses is proposed regarding their implications for immune development and function. Research in human ecological immunology is in its earliest stages, but this is a promising area of exploration, and one in which anthropology is well-positioned to make important contributions.

Adaptation, Physiological↗

PubMed2006

Emotional reactivity and the overreport of somatic symptoms: somatic sensitivity or negative reporting style?

OBJECTIVE: The purpose of this study is to examine the role of emotional reactivity (ER) in symptom reporting and conceptualize somatizing processes as a signal detection task. Emotional reactivity has been theorized to influence symptom reporting through somatic sensitivity as well as via a negative reporting style. We assess the degree to which these two competing theories about the role of ER are accurate within the signal detection framework. METHODS: We used a multimethod approach that included using both static and prospective self-reports as well as a signal detection task. RESULTS: Results suggest that ER exerts its influence on somatization tendencies via a negatively biased reporting style and is not mediated by somatic sensitivity as suggested by the somatosensory amplification and the symptom perception hypothesis. CONCLUSION: Emotional reactivity has yet to be associated with objective measures of somatic sensitivity. Until such an association is found, it is likely that ER influences symptom reports via negatively biased reporting.

Adolescent↗

PubMed2005

Computational models of working memory: putting long-term memory into context.

Detailed computational modeling of human memory has typically been aimed at either short-term (working) memory or long-term memory in isolation. However, recent research highlights the importance of interactions between these systems for both item and order information. At the same time, computational models of both systems are beginning to converge onto a common framework in which items are associated with an evolving "context" signal and subsequently compete with one another at recall. We review some of these models, and discuss a common mechanism capable of modelling working memory and its interaction with long-term memory, focussing on memory for verbal sequences.

Attention↗

PubMed1999

[Anorexia nervosa in children and adolescent: new therapeutic approaches].

Classical therapeutic recommendations requires that girls with anorexia nervosa be separated from their parents. Refeeding, and later individual psychodynamic approaches were also emphasized. These guidelines are now broadened towards psychotherapeutic approaches (psychodynamic, familial, cognitive-behavioral) associated with psychoeducational and dietetic strategies. In the Child and Adolescent Psychopathology Unit of Robert-Debre Hospital in Paris, individual therapeutic programs are applied to young anorectic girls and their families. These programs are implemented within an inpatient (full-time, part-time) or outpatient (consultations, weekly day-therapeutic program) framework. In order to forge a therapeutic alliance with parents and restore "parental competences" feelings, we do not separate any longer anorectic girls from their parents during hospitalization, and we have developed an alternative therapeutic model to full-time hospitalization.

Adolescent↗

PubMed2001

Do regulators of animal welfare need to develop a theory of psychological well-being?

The quest for a "theory of nonhuman minds" to assess claims about the moral status of animals is misguided. Misframed questions about animal minds facilitate the appropriation of animal welfare by the animal user industry. When misframed, these questions shift the burden of proof unreasonably to animal welfare regulators. An illustrative instance of misframing can be found in the US National Research Council's 1998 publication that reports professional efforts to define the psychological well-being of non-human primates, a condition that the US 1985 animal welfare act requires users of primates to promote. The report claims that "psychological well-being" is a hypothetical construct whose validity can only be determined by a theory that defines its properties and links it to observed data. This conception is used to contest common knowledge about animal welfare by treating psychological well-being as a mental condition whose properties are difficult to discover. This framework limits regulatory efforts to treat animal subjects less oppressively and serves the interests of the user industry.A more liberatory framework can be constructed by recognizing the contested nature of welfare norms, where competing conceptions of animal welfare have implications about norm-setting authority, as it does in other regulatory contexts, e.g., food safety,. Properly conceptualized welfare should include both the avoidance of distressful circumstances and the relationship between the animal's capacities to engage in enjoyable activities and its opportunities to exercise these capacities. This conception of animal welfare avoids appropriation by scientific experts. The development of the psychological well-being regulation is a good illustration of how social norms are contested and then appropriated, and a critique of this appropriation shows how it can be challenged.

Animal Welfare↗

PubMed2006

Information literacy for speech-language pathologists: a key to evidence-based practice.

PURPOSE: In this tutorial, we review the tenets of information literacy (IL) that parallel and intersect with new American Speech-Language-Hearing Association (ASHA) certification standards requiring clinicians to engage in evidence-based practice (EBP). METHOD: A review of the literature on EBP in medical and allied health areas was conducted through an online database search. The Information Literacy Competency Standards for Higher Education (American Library Association, 2004) are used as a framework for outlining IL practices that will aid in EBP. RESULTS: Current strategies are contrasted with more desirable strategies. Potential barriers to the utilization of information-literate procedures in locating sources of reliable clinical evidence are discussed together with potential solutions. CONCLUSION: Suggestions for more efficient information searches by clinicians, as well as a proposed discipline-wide agenda for increasing clinicians' IL skills during and after entry-level graduate training, are provided.

American Speech-Language-Hearing Association↗

PubMed2026

Estimating protein isoform abundances with [Formula: see text].

A single gene can encode multiple versions of a protein, dubbed isoforms, with varying functionality. Cellular control of isoform abundances is critical for multiple aspects of biology and is only partially regulated by transcript levels. While long-read sequencing facilitates transcript quantification, quantifying the resulting protein isoforms on a large scale is a major challenge, complicating biological interpretation of transcript alterations. Standard "bottom up" mass spectrometry can assess only short portions of isoforms called peptides, and these peptides often map onto more than one isoform. We introduce [Formula: see text] (Protein isoform Abundance Quantification), a Bayesian method that leverages multiomic information from the peptidome and transcriptome to provide accurate estimates of isoform abundance even when peptide mapping is ambiguous. [Formula: see text] offers several advantages over existing methods in a unified framework. It provides uncertainty quantification, integrates multiomic information for improved accuracy, and provides a rigorous framework for hypothesis testing. Extensive simulations show that [Formula: see text] consistently outperforms competing methods in detecting differentially abundant protein isoforms and estimating their abundances. We use [Formula: see text] to investigate differences in isoform abundance levels between people with schizophrenia and control subjects, confirming a long-held hypothesis that levels of the C4A isoform of Complement Component 4 are increased in schizophrenia while C4B is not. These results demonstrate that [Formula: see text] can identify significant variations in isoform abundance levels not previously possible.

Protein Isoforms↗

PubMedDate not supplied

Feminism: a perspective for the 21st century.

This article details some of the key elements related to feminism in American society. It suggests that the meaning and significance of a feminist perspective need to be reexamined for their importance and utility in this dynamic and rapidly changing society. A discussion of the meaning of feminism provides a framework for the article. Issues related to cultural diversity and the need for competent health care delivery for all people are some major themes. The other emphasis is related to research and women. Numerous challenges are outlined. A feminist perspective is recommended as a conceptual model through which health care reform can be enhanced. If feminism were embraced, the health status of people would be improved.

Cultural Diversity↗

PubMed1986

Recent advances in the pathogenesis and pathophysiology of bacterial meningitis.

Bacterial meningitis continues to account for worldwide morbidity and mortality despite the advent of effective bactericidal antibiotic therapy. Recent advances over the past 10 years in the development of experimental animal models as well as basic investigation into critical bacterial surface virulence factors have begun to clarify a conceptual framework for understanding the mechanism of meningitis development in humans. Basic observations regarding competing host defenses and bacterial virulence factors have supported a pathogenetic sequence of mucosal colonization with a meningeal pathogen; systemic host invasion with intravascular replication; blood brain barrier penetration and unimpeded CSF proliferation amid the impaired host defenses in the CSF milieu; and pathophysiologic sequelae including vasogenic, cytotoxic, and interstitial brain edema (and other processes) accounting for irreversible neuronal injury and death. Only through continued basic investigation into each of these pathogenetic steps will significant reductions in morbidity and mortality ensue.

Animals↗

PubMed2005

Developing and validating a tool to measure parenting self-efficacy.

AIMS: This paper reports the development of a tool to measure parenting self-efficacy as an aid to evaluating parenting programmes. BACKGROUND: Whilst there has been increasing interest in parenting programmes from parents, government and professionals, there is a lack of rigorous evaluation studies of their effectiveness, particularly their longer-term outcomes. Equally, there is little research evidence of the views and experiences of parents themselves. It is important to develop robust outcome measures which draw on well-developed theoretical constructs to measure parents' perceived abilities to manage their children based on their own views and experiences. Self-efficacy, a self-perception of one's ability to perform competently and effectively in a particular task or setting, may provide such a framework. METHODS: Data from 12 focus groups conducted with parents and parenting programme facilitators informed the development of the tool. A thematic analysis of the focus group transcripts identified key items to be included in the self-efficacy instrument, and these were developed into 82 Likert-format statements. A multi-method approach was used to test the instrument for validity and reliability. FINDINGS: Nine domain specific sub-scales of parenting were identified from the analysis of the focus group data. Internal reliability coefficients for the subscales ranged from 0.80 to 0.89, and the overall scale reliability was 0.94. External reliability coefficients ranged from rs = 0.58 (n = 19, P < 0.01) to rs = 0.88 (n = 19, P < 0.01). CONCLUSION: A valid and reliable tool to measure parenting self-efficacy has been developed, which will aid evaluation of parenting programmes.

Adult↗