A framework for perioperative advanced practice.
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Humans↗
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Results for “Competency framework”
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The roles of physician-executives in hospitals: a framework for management education.
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Hospital Administration↗
A framework for evaluation of scientific research papers.
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Data Collection↗
The clinical nurse specialist as expert practitioner in the obstetrical/gynecological setting.
The role of the advanced practice nurse (APN) continues to evolve in specialty areas while healthcare systems seek solutions to issues of cost-containment, equity in access, and quality care. APNs have a significant role in facilitating the positive outcomes of clients utilized as measurable indicators in a managed care environment. The CNS as expert practitioner in the obstetrical/gynecological hospital setting integrates specialty knowledge and demonstrates specialty skills when working with childbearing and perimenopausal women and their families. Maintaining a holistic orientation to practice and keeping comprehensive documentation of activities facilitate achievement of quality outcomes for patients in this specialty field. Competencies essential to successful implementation of the expert practitioner role include: clinical expertise, effective communication skills, critical thinking and analytical skills, and a theoretical orientation to problem solving. The Roy Adaptation Model is an effective framework that can be used by the CNS in the obstetrical/gynecological hospital setting to promote, maintain, and restore health, as well as facilitate positive patient outcomes.
Adaptation, Psychological↗
Incorporating multiculturalism into oncology nursing research: the last decade.
PURPOSE/OBJECTIVES: To use the Oncology Nursing Society's cultural competence guidelines to review research studies conducted by oncology nurse researchers with racial and ethnic minorities and published in the Oncology Nursing Forum during 1990-2000. DATA SOURCES: Using selected key words (e.g., cultural competence, cultural diversity, multiculturalism, minorities, African American/Black American, Hispanic/Latino, Asian/Pacific Islander, Native American/Alaskan Natives) the authors identified 27 studies that met the inclusion criteria for review. Case studies, sponsored lectureships, review articles, commentaries, editorials, and the like were excluded. DATA SYNTHESIS: Within the context of the cultural competence guidelines, the primary strengths included sufficient background information and literature to establish the existence of the problem in the targeted culture, use of conceptual and theoretical frameworks to guide the study, identification of salient study limitations, and recommendations for dissemination of the findings to a general audience. Limitations included discussion of culture beyond the background and literature review, consideration of potential ethical concerns the target population may have about the methods to be used, inclusion of racial and ethnic minorities in the design and implementation of the study, and implications for oncology nursing education. CONCLUSIONS: Although much has been gleaned from previous oncology nursing research published from 1990-2000, more fully incorporated content related to cultural competence is needed. This is needed particularly in studies specifically targeting racial and ethnic minority populations. IMPLICATIONS FOR NURSING: Including cultural competence when designing and reporting research has a greater potential to inform oncology nursing practice, design future research studies, strengthen existing nursing curricula, and help to shape health policy related to racial and ethnic minority populations. The Oncology Nursing Society Multicultural Outcomes: Guidelines for Cultural Competence provides guidance for enhancing the next generation of oncology nursing research with ethnically and culturally diverse populations.
Adult↗
Developing clinical expertise in the care of addicted patients in acute care settings.
Patients with problems related to addiction are frequently encountered in acute care hospitals. Behavioral difficulties and other obstacles to treatment often threaten the smooth application of compassionate plans of care for these patients. The authors describe the use of an addiction nurse expert and a group of clinical resource nurses to advance the level of practice at one institution with regard to addicted patients. The work of Benner on the process of skill acquisition in nursing is used as a framework for the discussion.
Adult↗
The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines.
Clinical guidelines can be viewed as generic skeletal-plan schemata that represent clinical procedural knowledge and that are instantiated and refined dynamically by care providers over significant time periods. In the Asgaard project, we are investigating a set of tasks that support the application of clinical guidelines by a care provider other than the guideline's designer. We are focusing on the application of the guideline, recognition of care providers' intentions from their actions, and critique of care providers' actions given the guideline and the patient's medical record. We are developing methods that perform these tasks in multiple clinical domains, given an instance of a properly represented clinical guideline and an electronic medical patient record. In this paper, we point out the precise domain-specific knowledge required by each method, such as the explicit intentions of the guideline designer (represented as temporal patterns to be achieved or avoided). We present a machine-readable language, called Asbru, to represent and to annotate guidelines based on the task-specific ontology. We also introduce an automated tool for the acquisition of clinical guidelines based on the same ontology, developed using the PROTEGE-II framework.
Artificial Intelligence↗
A study of perianesthesia nursing practice: the foundation for newly revised CPAN and CAPA certification examinations.
The CPAN and CAPA nursing certification programs, sponsored by ABPANC, are designed to promote and enhance the quality of care delivered to patients who have received anesthesia. This article describes ABPANC's most recent Role Delineation Study (RDS), also called the Study of Practice. The work of a think tank that convened to reconceptualize the organizing framework for the certification examination programs is described, including the results of an environmental analysis. A variety of methods were used to conduct the study. As a result of study findings, the CPAN and CAPA programs have been redesigned to focus on the physiological, behavioral and cognitive, safety, and advocacy needs of perianesthesia patients. Those needs and the knowledge base that is required of perianesthesia nurses to meet those needs are defined. The first CPAN and CAPA examinations using the new framework will be given November 3, 2001.
Certification↗
Clinical education model for staff training in orthopedic manual therapy.
We designed a clinical education model for training staff orthopedic physical therapists to provide basic skills in orthopedic manual therapy. The program evolved in a health maintenance organization, where a large number of patients with acute and chronic musculoskeletal disorders receive care. As physical therapy became primary in the treatment of these patients, the staff needed to develop specialized clinical skill. We divided the program into four phases: Phase I--Lecture Series, Phase II--Evaluation of Clinical Skill, Phase III--Self-directed Study, and Phase IV--Re-evaluation. This clinical education assures the staff physical therapist of a supportive learning environment. The program enhances clinical development by identifying individual strengths and weaknesses and providing a positive framework for improvement and self-evaluation.
Clinical Competence↗
A clinical pathway for endoscopy.
The purpose of this article is to describe the development and use of a clinical pathway in an endoscopy setting. The goal was to incorporate all of the established practices of each discipline--nursing, medicine, admissions, laboratory, radiology, and others--without changing their practice models. The clinical pathway is the framework for all the activities in the management and practice of the unit, including the nursing standard of care, nursing competency-based practice, hospital policy and procedures, quality improvement, risk management, and physician preference.
Critical Pathways↗
Ethical issues in providing occupational health services.
In the rush to capture new segments of the health care market, occupational health services have become an attractive "product line" for some provider groups. However, providers may not appreciate the significant ethical dimensions of delivering occupational health services. The environment of the workplace gives rise to competing goals, interests, and expectations and creates thorny ethical issues for health care providers. It is important that providers develop a framework for recognizing and addressing these ethical issues and the influence of their own and other parties' values on their decision-making processes.
Adult↗
Impact of illness and its treatment on workplace costs: regulatory and measurement issues.
In an attempt to document a broader spectrum of the benefits of their pharmaceutical products, drug companies increasingly seek to include productivity claims in their promotional campaigns. We describe the existing regulatory framework of the Food and Drug Administration (FDA) for considering productivity claims, distinguishing between the traditional "substantial evidence" standard and the "competent and reliable scientific evidence" standard. But the notion of competent and reliable scientific evidence may itself be problematic, even when it is the appropriate regulatory standard, because there exists no consistent measurement approach across diseases, workplaces, jobs, and worker capabilities that is widely accepted in this emerging area of health outcomes research. We examine the various measurement approaches that have been used to quantify the impact of illness and its treatment on workplace productivity, and we describe some of the shortcomings associated with each alternative. This discussion highlights the possible difficulties faced by the FDA in reviewing productivity-based promotional claims. Finally, we suggest possible strategies for furthering this field of investigation.
Absenteeism↗
Molecular genetics of auxin signaling.
The plant hormone auxin is a simple molecule similar to tryptophan, yet it elicits a diverse array of responses and is involved in the regulation of growth and development throughout the plant life cycle. The ability of auxin to bring about such diverse responses appears to result partly from the existence of several independent mechanisms for auxin perception. Furthermore, one prominent mechanism for auxin signal transduction involves the targeted degradation of members of a large family of transcriptional regulators that appear to participate in complex and competing dimerization networks to modulate the expression of a wide range of genes. These models for auxin signaling now offer a framework in which to test how each specific response to auxin is brought about.
Amino Acid Sequence↗
Development of the psychotherapy supervisor: concepts, assumptions, and hypotheses of the supervisor complexity model.
The growth of the psychotherapy supervisor has been a much neglected topic in the clinical supervision literature. In an effort to better address this area, a four-stage model of development through which psychotherapy supervisors generally are thought to pass has been proposed. To further flesh out this model and render its substance more explicit, this paper complements the earlier explication by (a) providing basic foundation material that supports and underlies it and (b) providing additional material that extends it. The concepts, assumptions, and hypotheses of the Supervisor Complexity Model (SCM) have been identified and delineated. Some attention has also been given to how research on the SCM might best proceed. Specifying the model in this way seems important if it is to be subject to further professional scrutiny (so that refinements/revisions in it can be made), if it is to be rendered most researchable as a heuristic paradigm, if it is to be more solidly grounded within a developmental framework, and if it is to ultimately inform supervision practice.
Clinical Competence↗
Ought low alcohol intake to be promoted for health reasons?
There is increasingly widespread acceptance that alcohol taken in moderation by the population aged 35 years or older reduces the risks of ischaemic heart disease and all-cause mortality. Ten causal criteria are used to evaluate the scientific evidence for a protective effect of low alcohol intake on ischaemic heart disease. Inferences for public policy are then assessed using the principles of beneficence, non-maleficence, justice and autonomy to support a framework of nine ethical considerations: intervention versus causation; effect modification by gender, smoking, biogenetic and other factors; inappropriate adoption of recommendations; competing hazards between atherosclerotic disease and cancer; opportunity cost; equity of access; the value system used to judge outcomes; the degree of social influence warranted; and consent and responsibility. We conclude that in the absence of more adequate scientific knowledge and informed community debate it is unethical to promote low alcohol intake as a preventive health measure.
Alcohol Drinking↗
IV steroids for MS relapse: clinical governance implications.
The face of the NHS is set to change enormously during the next decade providing more choice, more personalized care and real empowerment of people to improve their health (Department of Health, 2005b). Fundamental to this approach will be the management of patients' health needs in the community setting. Using a robust clinical governance framework, the MS team at the National Hospital for Neurology and Neurosurgery worked with the voluntary and commercial sector to design a trial to gather evidence for a new approach to the management of acute MS relapse using intravenous steroids within a home environment. The study was completed in advance of recent governmental initiatives/reforms. This paper focuses on the clinical governance implications of cross-boundary working. It is hoped that by sharing the processes put in place, others contemplating the delivery of acute care outside of hospitals or design of collaborative research trials will find the frameworks useful.
Anti-Inflammatory Agents↗
[Value of a consultation center and crisis intervention in addressing psychiatric disorders in the perinatal period].
The Psychiatry department of the University Hospital Centre of Lille has developed, over the last 10 years, a treatment network for psychiatric disorders during pregnancy or in the post-partum period. There are liaison consultations in the maternity department, screening and management of psychopathological disorders in the perinatal period, training of midwives, support of patients seeking genetic counselling, collaboration with teams providing "medically-assisted procreation", etc. For severe disorders of the post-partum period (severe depression, serious alteration of mother-child interaction, puerperal psychosis), the Psychiatry department has a specialized unit where 3 "mother-child" groups can be admitted. This unit is particularly effective if the patients and their family understand this healthcare system and stick to it to a certain extent. Even if improvements are always possible, cases in which situations occur as an emergency, are when dysfunctions are most frequently seen. On 7th December 1998, a Crisis Intervention Unit (CIU) was created with 15 short-term beds, for stays up to 72 hours. The CIU was opened in the Psychiatry department, close to the main Accident and Emergency department, with 2 aims: firstly to provide a setting and resources for a number of emergency psychiatric situations, and secondly to provide a place and time for crisis situations which we admit to the unit, with a view to facilitating interaction and to propose in certain cases a process of crisis intervention, which later continues on an outpatient basis. After being open for a year, the CIU has proved to be an improvement to all of the healthcare services which are available. It should be noted that the situations which need highly specialized resources in such a short time, are those which cause the most acute problems. This is at times when the emergency services network, with its internal logic, require another network based on a different logic, that the interface problems are at their most acute. The situations reported here, which require a fluid interface between the emergency services and the "mother-child" networks, are examples. We report 3 clinical situations, which illustrate 3 possibilities of action: the first, in which 2 successive stays in the CIU allowed an admission to the "mother-child" unit in satisfactory conditions, the second, in which overall management was based on hospitalization in the Obstetrics department and several visits to our Unit, and the last one, in which the whole medico-psycho-social approach was set up after a single stay of 3 days. Since the opening of Crisis Intervention Unit, around 1,000 patients have been treated there; 37 were women with difficulties with their pregnancy, 17 of whom required direct intervention by the "mother-child" team. The contexts were: 5 prenatal depressions, 4 post-partum depressions, 3 cases of hyperemesis gravidarum, 5 rejections of pregnancy and/or situations at risk of infanticide. The almost constant suicidal risk should be noted, or even attempted suicide, at the time of admission to the CIU. The other 20 women had psychopathological disorders linked to sterility, medically-assisted pregnancy, termination of pregnancy or pregnancy in women suffering from long-term somatic illnesses (insulin-dependent diabetes, lupus, etc.). When a psychopathological episode occurs during pregnancy, it is essential to preserve the developing relationship with the child in an intermediate place, in a healthcare perspective and to prevent any future impairment of the quality of the mother-child relationship by the psychiatric disorder. The Crisis Intervention Unit is not an emergency "mother-child" unit. Other French experiences have been reported, an example being mother-baby hospitalization in a crisis centre. The aim of our interventions is not the same, and our local context, together with the availability of a healthcare network on different floors, which is specific and close-by, allows this approach. Also, the contribution of Liaison Psychiatry in emergency situations should not be minimized. It is necessary to work in collaboration with the obstetricians. In fact, the chance to work with us was given by asking for a hospitalization in the Obstetric unit, during the prepartum period of pregnancies with a psychiatric risk. This way of proceeding allows somatic monitoring in hospital to be performed, whenever the risk run by the mother and/or the child requires it. This "analogue" procedure, however preventative it may be, does not always allow specific treatment of the psychiatric disorders to be given, despite liaison psychiatry interventions. Our interventions are not a specialized "mother-child" unit, or a substitute for Liaison Psychiatry, but they are specifically aimed at the context of the crisis. Obviously, it is precisely this dimension of the crisis which makes the other types of management temporarily unsuitable. This new working framework, with the simple possibility of admitting women and interacting with them in a crisis situation, with the aid of the competence of "mother-child" teams, most often seems to allow an alternative to hospitalization in the Psychiatry department, at the same time keeping up quality management of problems linked to the pregnancy or post-partum period. The specificity of the CIU, with its project of taking the special psychiatric vulnerability of pregnancy into account, makes sure that the psychopathological aspects of the crisis situation and the physiological aspects of adaptation reactions to the perinatal period are not neglected, but that are respected by this type of interaction/intervention.
Adult↗
Theoretical models for application in school health education research.
Theoretical models that may be useful to research studies in school health education are reviewed. Selected, well-defined theories include social learning theory, problem-behavior theory, theory of reasoned action, communications theory, coping theory, social competence, and social and family theories. Also reviewed are multiple theory models including models of health related-behavior, the PRECEDE Framework, social-psychological approaches and the Activated Health Education Model. Two major reviews of teaching models are also discussed. The paper concludes with a brief outline of the general applications of theory to the field of school health education including applications to basic research, development and design of interventions, program evaluation, and program utilization.
Adolescent↗