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PubMed1995

The use of reflection to enhance practice.

Reflection enables learning to occur from immediate experiences, from which theory and frameworks of care can be developed. Reflection heightens self-awareness, enabling increased understanding of the effects that past experiences may have on care delivery. Personal and professional development occurs through the process of reflection. Kolb's experiential learning theory provides a framework for reflection, focusing on the role of experience in learning.

Clinical Competence↗
PubMedDate not supplied

The development of an acute care case manager orientation.

The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.

Acute Disease↗
PubMed1998

Beyond coverage and supply: measuring access to healthcare in today's market.

OBJECTIVE/PURPOSE: To stimulate discussion within the research and policy community about the value of and issues surrounding different ways to describe access to care in a health system reconfigured by the growth of managed care, competition, and other marketplace changes. PRINCIPLE FINDINGS: The concept of access has evolved over time to address shifting health policy concerns like the growing interest in looking beyond utilization as a measure of access to a better consideration, too, of the effectiveness of services used as judged by costs and outcomes. Yet current frameworks used to look at access are person-based and do not capture the complexity of the healthcare system and the complex structures involved in managed care organizations that combine delivery and financing and vary substantially within and across markets. In addition, many at times competing or conflicting policy goals on access exist. There also is an increasingly diverse and widening set of uses that include benchmarking against national goals, measuring performance of accountable entities, and providing consumer information. CONCLUSIONS AND RECOMMENDATIONS: Traditional access frameworks are invaluable in encouraging focus on historical measures of access, like insurance coverage and other barriers to system entry. But much greater attention needs to be paid to adapting current access frameworks so that they also better support the ability to understand how processes inherent in diverse health delivery and financing arrangements influence access to services within a system and what this means for how well individuals negotiate healthcare systems and the effects on care outcomes. The increasing demands on access measures and the growing diversity of users also point to a need for collaboration to better pool insights, share experiences, and honestly confront trade-offs or disagreements to progress in addressing these issues.

Delivery of Health Care↗
PubMed2005

United snakes.

Since their debut in 1987, snakes (active contour models) have become a standard image analysis technique with several variants now in common use. We present a framework called "United Snakes", which has two key features. First, it unifies the most popular snake variants, including finite difference, B-spline, and Hermite polynomial snakes in a consistent finite element formulation, thus expanding the range of object modeling capabilities within a uniform snake construction process. Second, it embodies the idea that the heretofore presumed competing technique known as "live wire" or "intelligent scissors" is in fact complementary to snakes and that the two techniques can advantageously be combined by introducing an effective hard constraint mechanism. The United Snakes framework amplifies the efficiency and reproducibility of the component techniques, and it offers more flexible interactive control while further minimizing user interactions. We apply United Snakes to several different medical image analysis tasks, including the segmentation of neuronal dendrites in EM images, dynamic chest image analysis, the quantification of growth plates in MR images and the isolation of the breast region in mammograms, demonstrating the generality, accuracy and robustness of the tool.

Algorithms↗
PubMed2003

Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study.

The objective of this study was to identify possible obstacles to carrying out competent early identification and brief intervention (EIBI) of heavy drinkers in primary health care. Qualitative focus group discussion method study applying the deductive framework approach. Six focus groups involving 18 general practitioners and 19 nurses were recruited from primary health care of the City of Tampere, Finland. Possible obstacles are: (1) confusion regarding the content of early-phase heavy drinking, (2) lack of self-efficacy among primary health care professionals, (3) sense of lacking time needed for carrying out brief intervention, (4) not having simple guidelines for brief intervention, (5) sense of difficulty in identifying of early-phase heavy drinkers, and (6) uncertainty about the justification for initiating discussion on alcohol issues with patients. The main actions to be taken to promote brief intervention are to educate professionals about the content of early-phase heavy drinking and to produce directing, but not excessively demanding guidelines for carrying out EIBI. Probably successful personal experiences carrying out EIBI can improve professionals' self-efficacy and give to them final justification for discussion alcohol issues with their patients.

Alcoholism↗
PubMed2005

Developing postoperative pain management: utilising the promoting action on research implementation in health services (PARIHS) framework.

BACKGROUND: The development of acute pain services (APS), education programmes, and protocols assumed an expectation that health care professionals would integrate evidence into everyday practice. However, research evidence into pain management would suggest that this is not the case. APPROACH: Through a review of the literature, the authors aim to (1) explore the factors that have a significant influence on getting evidence into practice (using the PARIHS model as a guide) and (2) examine the relevance of these factors to postoperative pain practices. FINDINGS: The need to assist clinicians with developing a greater awareness of the competing and complex influences that surround pain management practices is outlined. RECOMMENDATIONS: There is a necessity to adopt a systematic, rigorous, and multidimensional approach to pain management issues, utilising the PARIHS framework as a guide, to improve pain practices.

Culture↗
PubMed2003

Exploring the overproduction of amino acids using the bilevel optimization framework OptKnock.

In this study, we modify and extend the bilevel optimization framework OptKnock for identifying gene knockout strategies in the Escherichia coli metabolic network, leading to the overproduction of representative amino acids and key precursors for all five families. These strategies span not only the central metabolic network genes but also the amino acid biosynthetic and degradation pathways. In addition to gene deletions, the transport rates of carbon dioxide, ammonia, and oxygen, as well as the secretion pathways for key metabolites, are introduced as optimization variables in the framework. Computational results demonstrate the importance of manipulating energy-producing/consuming pathways, controlling the uptake of nitrogen and oxygen, and blocking the secretion pathways of key competing metabolites. The identified pathway modifications include not only straightforward elimination of competing reactions but also a number of nonintuitive knockouts quite distant from the amino acid-producing pathways. Specifically, OptKnock suggests three reactions (i.e., pyruvate kinase, phosphotransacetylase, and ATPase) for deletion, in addition to the straightforward elimination of 2-ketoglutarate dehydrogenase, to generate a glutamate-overproducing mutant. Similarly, phosphofructokinase and ATPase are identified as promising knockout targets to complement the removal of pyruvate formate lyase and pyruvate dehydrogenase for enhancing the yield of alanine. Although OptKnock in its present form does not consider regulatory constraints, it does provide useful suggestions largely in agreement with existing practices and, more importantly, introduces a framework for incorporating additional modeling refinements as they become available.

Algorithms↗
PubMedDate not supplied

Role modelling as a teaching method for student mentors.

Nurses, midwives and health visitors working as mentors are required to help their students to develop both competence and confidence in their practice. Faced with increasing workloads, practitioners need to consider alternative approaches to teaching and learning. Role modelling may be the most appropriate approach because it enables students to work alongside practitioners. However, it is often underused. This article outlines positive and negative role-modelling behaviours using moving and handling to illustrate a framework for this.

Attitude of Health Personnel↗
PubMed2006

Cultural aspects of communication in cancer care.

Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase, and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancer care leads to improved therapeutic outcome and it may decrease disparities in medical care. Cultural competence in medicine is a complex multilayered accomplishment, requiring knowledge, skills and attitudes whose acquisition is needed for effective cross-cultural negotiation in the clinical setting. Effective cultural competence is based on knowledge of the notion of culture; on awareness of possible biases and prejudices related to stereotyping, racism, classism, sexism; on nurturing appreciation for differences in health care values; and on fostering the attitudes of humility, empathy, curiosity, respect, sensitivity and awareness. Cultural competence in healthcare relates to individual professionals, but also to organizations and systems. A culturally competent healthcare system must consider in their separateness and yet in there reciprocal influences social, racial and cultural factors. By providing a framework of reference to interpret the external world and relate to it, culture affects patients' perceptions of disease, disability and suffering; degrees and expressions of concern about them; their responses to treatments and their relationship to individual physicians and to the healthcare system. Culture also influences the interpretation of ethical norms and principles, and especially of individual autonomy, which can be perceived either as synonymous with freedom or with isolation depending on the cultural context. This, in turn, determines the variability of truth-telling attitudes and practices worldwide as well as the different roles of family in the information and decision-making process of the cancer patient. Finally, culture affects individual views of the patient-doctor relationship in different contexts.

Communication↗
PubMed1990

Social work in health care: directions in practice.

As technological advances within biomedicine uncover more complex and confusing situations, social workers are forced to deal with the patient and family with greater uncertainty. To competently address today's biomedical environment with an anticipation of tomorrow's advances is an incredible challenge. The focus of the theoretical framework necessary as the foundation for health care practice has shifted from an emphasis on psychopathology to a focus on what people do well, on their adaptive capacities with the goal of preventing maladaptive behavior. Therefore, the focus of practice must be on factors that affect normal or typical growth and development in the course of living and must include an understanding of the interaction between the biological, psychological, cognitive, social, cultural, and environmental dimensions of social functioning.

Ethics, Professional↗
PubMed2005

Emotion work and boundary maintenance in hospital-based midwifery.

OBJECTIVE: To identify and explore the emotion work of hospital-based midwives. DESIGN: An ethnographic approach using focus groups, observations and interviews. SETTING: South Wales, UK. PARTICIPANTS: Phase one of the study: self-selected convenience sample of 27 student midwives in first and final years of 3-year (direct entry) and 18-month (post-nursing) programmes. Phase two: opportunistic sample of seven qualified hospital-based midwives. Phase three: Purposive sample of 10 hospital-based midwives working within one National Health Service Trust. Sample representative of a range of clinical locations, length of clinical experience and clinical grades. FINDINGS: The emotion work of midwives was strongly influenced by the context of practice. For hospital-based midwives, relationships with midwifery colleagues were of key importance, providing the main source of feedback on individual practice. Negotiating these relationships was a major source of emotion work. Although collegial relationships could provide support and affirmation, they were also a frequent source of conflict, particularly between junior and senior midwives. This discord was underpinned by conflicting ideologies of midwifery practice. KEY CONCLUSIONS: The theoretical framework of boundary maintenance was used to interpret the findings. Senior and junior midwives frequently held contradictory models of practice, resulting in competing claims for occupational jurisdiction. Midwives made use of a variety of devices in order to establish and maintain intra-occupational boundaries. Senior midwives attempted to maintain their position through unwritten rules and sanctions, supported by their claim to greater clinical expertise and experience. Junior midwives rarely challenged this authority; their responses were often subversive and designed to create an appearance of compliance. IMPLICATIONS FOR PRACTICE: These findings contribute to our understanding of inter-collegial conflict in UK midwifery, providing insights into workplace harassment and low staff morale, which are likely to exacerbate workforce attrition. The underpinning ideological dissonance experienced by midwives must be acknowledged and tackled for these issues to be effectively addressed.

Adult↗
PubMed1988

Goals: an approach to motivation and achievement.

This study tested a framework in which goals are proposed to be central determinants of achievement patterns. Learning goals, in which individuals seek to increase their competence, were predicted to promote challenge-seeking and a mastery-oriented response to failure regardless of perceived ability. Performance goals, in which individuals seek to gain favorable judgments of their competence or avoid negative judgments, were predicted to produce challenge-avoidance and learned helplessness when perceived ability was low and to promote certain forms of risk-avoidance even when perceived ability was high. Manipulations of relative goal value (learning vs. performance) and perceived ability (high vs. low) resulted in the predicted differences on measures of task choice, performance during difficulty, and spontaneous verbalizations during difficulty. Particularly striking was the way in which the performance goal-low perceived ability condition produced the same pattern of strategy deterioration, failure attribution, and negative affect found in naturally occurring learned helplessness. Implications for theories of motivation and achievement are discussed.

Achievement↗
PubMed1999

New directions for risk communication research: a discussion with additional suggestions.

The papers by Huerta and Macario and Kreuter share the theme of suggesting new directions for risk communication research in cancer prevention and control. Huerta and Macario remind us once again that sociocultural factors must be considered when conducting risk communication research on underserved populations. Of special note is their recommendation to target the family, which could introduce a compelling new chapter in risk communication research in cancer prevention and control. In contrast, Kreuter challenges us to consider multiple cancer risks and risk-reducing behaviors in our research and provides a provocative framework for achieving this goal. Given this common theme and the need to position specific recommendations within the larger context of other competing research questions, this paper also highlights several additional recommendations for future research. These recommendations include the following: more research on risk presentation; establishing guidelines for measuring risk; additional research testing strategies to de-bias optimistic and pessimistic perceptions of risk and evaluating risk communication as a strategy for behavior change; more research investigating the sociology of risk communication, with a special emphasis on the family as the unit of investigation; and, finally, more research that specifically targets underserved populations in diverse community settings.

Communication↗