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PubMedDate not supplied

Facilitating the implementation of lifelong learning in nursing.

Lifelong learning in nursing comprises an essential conceptual shift from the notion of the registered nurse (RN) being merely a competent health service incumbent to one who engages in professional learning continuously throughout their career in order to keep their knowledge and skills up to date. Since the 1990s, lifelong learning has appeared as a rhetoric within nursing literature in the UK, with a seemingly general assumption that there is a shared understanding and acceptance of the concept among all nurses. A literature review on lifelong learning shows that the concept comprises a number of components. However, because the literature does not seem to address the application of the concept to nursing, a study that aimed to ascertain RNs' perceptions of lifelong learning, and their views on the mechanisms that would enable effective implementation of the concept, was conducted. This qualitative study entailed individual interviews with 26 RNs and two focus groups with another 12 RNs. The findings suggest that there are positive perceptions as well as certain reservations about lifelong learning among RNs, and that structural mechanisms could be more firmly and equitably anchored. Additionally, profession-based and informal personal networks tend to play a key role in encouraging and supporting learning. The results of the study are configured into a conceptual framework for the implementation of lifelong learning in nursing and possibly in other health professions.

Clinical Competence↗
PubMed1994

Defining the specialization of pediatric occupational therapy.

OBJECTIVES: Occupational therapists who work primarily with children were surveyed regarding their skill levels in competencies that define pediatric practice. METHOD: The subjects were 90 advanced practitioners who received specialty certification in pediatric occupational therapy in 1992 and 52 inexperienced practitioners with 5 or fewer years' experience. Respondents rated themselves from needs assistance to highly skilled on 94 competencies. RESULTS: A principle components analysis of the 142 surveys identified six primary constructs that described related areas of skill in the respondents: child evaluation, communication and consultation, working with families, understanding service provision systems, use of assistive technology, and neonatology and feeding. Child evaluation, with emphasis on developmental framework, analysis of sensory integration, and neuromotor function, was the strongest construct; respondents rated it the highest. Communication and consultation with team and family members also received high ratings. The advanced practitioner respondents rated themselves higher than the inexperienced practitioner respondents in 73 of the 80 competencies in the factors identified. The differences were greatest in the competencies of analysis of sensory processing and integration, analysis of neuromotor components, and consultation with other professionals. CONCLUSION: Findings suggest that advanced practitioners develop expertise in sensory integration and neuromotor analysis, and that evaluation and consultation are important skill areas in advanced occupational therapy practice.

Adult↗
PubMed2006

[General practice research supervision].

INTRODUCTION: General practice is a subject with a relatively short scientific tradition. The purpose of this study was to elucidate who gives long-cycle general practice research supervision in Denmark, who is supervised and how research students get on. MATERIALS AND METHODS: All research students with research advisers in the field of general practice filled out a questionnaire in 1997 (n = 50) and 2003 (n = 52). There were questions about project/research training, professional education, advisers and the students' attitude to taking on advisory functions in the future. In 2003, 48 of those from the 1997 cohort also answered a follow-up questionnaire. RESULTS: The number of research students with a connection to the general practice research field was fairly constant from 1997 to 2003. The number of permanently employed general practice advisers, on the other hand, has doubled, and these now undertake more of the advisory functions. The great majority of research students complete their projects, most of them at PhD level. Most of the research students surveyed indicated that they are prepared to take on advisory functions when they have acquired the competence to do so. DISCUSSION: The general practice research students vary greatly with regard to age, interests and career paths, but almost all complete their research studies. This may be due to the flexible framework for research in general practice and the increase in recent years of advisory capacity in general practice. This positive development is expected to continue through the development of networks, course activities and continuing follow-up of the advisory functions.

Biomedical Research↗
PubMed2006

Pseudopolymorphism of aliphatic amine/4-tert-butylcalix[4]arene inclusion compounds: supramolecular stabilization as a route to polar clusters and layers.

4-tert-Butylcalix[4]arene (4tBC4A) is a versatile host capable of forming a variety of 1:1 and 2:1 inclusion compounds typically stabilized through van der Waals interactions. Preliminary studies in our group have demonstrated that inclusion of n-butylamine in 4tBC4A results in a series of pseudopolymorphic inclusion compounds, including a new 3:1 inclusion motif. Using a combination of SCXRD, TGA, solid state NMR, and PXRD, we now elaborate upon the relationship between these pseudopolymorphs. We also demonstrate that larger amines demonstrate a similar degree of pseudopolymorphism, allowing for the production of customized materials using self-assembly guided by competing weak forces. Finally, we comment on the structural implications of the relative dominance such forces in the formation of calixarene-based supramolecular frameworks.

Journal Article↗
PubMed1977

A computer program for multiple decrement life table analyses.

Life table analysis has traditionally been the tool of choice in analyzing distribution of "survival" times when a parametric form for the survival curve could not be reasonably assumed. Chiang, in two papers [1,2] formalized the theory of life table analyses in a Markov chain framework and derived maximum likelihood estimates of the relevant parameters for the analyses. He also discussed how the techniques could be generalized to consider competing risks and follow-up studies. Although various computer programs exist for doing different types of life table analysis [3] to date, there has not been a generally available, well documented computer program to carry out multiple decrement analyses, either by Chiang's or any other method. This paper describes such a program developed by Research Triangle Institute. A user's manual is available at printing costs which supplements the contents of this paper with a discussion of the formula used in the program listing.

Computers↗
PubMed1989

Collaboration projects between nursing education and nursing service: a case study.

Collaboration refers to a variety of efforts to blend nursing education and nursing service. A regional planning agency in Southwestern Pennsylvania assumed a strategic role in developing a collaboration action plan which was expressed in three pilot demonstration projects involving an associate degree, a baccalaureate, and a diploma program with their respective service partners. The purpose of this 2 year evaluation case study was to assess the extent to which the three demonstration projects met their stated goals and objectives. The sample was self selected from the pool of nursing education programs and hospitals in the ten county Southwestern Pennsylvania planning region based on willingness to participate and compliance with project criteria. Suchman's model was used as the framework from which to evaluate the projects. Program participants indicated that the project resulted in enhancement of the school-agency relationship, more confident, competent students, and increased enthusiasm among staff who perceived they had a stake in the educational process. This study has implications for nursing practice, education and research. The implementation of well-planned collaboration projects yield many benefits, chief of which is enhanced co-operation between nursing service and nursing education. The benefits are valuable for international colleagues who may be testing out similar approaches in their respective countries.

Education, Nursing↗
PubMed2001

A dynamic programming approach to the efficient design of clinical trials.

If the prospective evaluation of all feasible strategies of patient management is not possible or efficient then this poses a number of questions: (i) which clinical decision problems will be worth evaluating through prospective clinical research; (ii) if a clinical decision problem is worth evaluating which of the many competing alternatives should be considered "relevant" and be compared in the evaluation; (iii) what is the optimal (technically efficient) scale of this prospective research; (iv) what is an optimal allocation of trial entrants between the competing alternatives; and (v) what is the value of this proposed research? The purpose of this paper is to present a Bayesian decision theoretic approach to the value of information which can provide answers to each of these questions. An analysis of the value of sample information was combined with dynamic programming and applied to numerical examples of sequential decision problems. The analysis demonstrates that this approach can be used to establish: optimal sample size; optimal sample allocation; and the societal payoff to proposed research. This approach provides a consistent way to identify which of the competing alternatives can be regarded as "relevant" and should be included in any evaluative study design. Bayesian decision theory can provide a general methodological framework that can ensure consistency in decision making between service provision, research and development, and the design, conduct and interpretation clinical research.

Bayes Theorem↗
PubMedDate not supplied

International Health Fellowship: a proposed curriculum for emergency physicians.

There are a growing number of emergency physicians (EPs) working in health care abroad. There are, however, no formal training programs for EPs in international health. An International Health Fellowship has been developed to provide training for EPs in public health and international medicine. The fundamental competencies of a fellow completing the International Health Fellowship include assessment of medical need, program development, integration of programs into the existing health care framework, and evaluation of projects. This article outlines the philosophy of a training program in international health, provides an overview of the goals and objectives for such a program, and describes the development of an existing fellowship. The International Health Fellowship will develop leaders in the field of global health by combining clinical expertise, practical field experience, formal public health training, and research and education in international health. Physicians completing a fellowship will be prepared to work within foreign health systems to develop, integrate, and evaluate health care programs on an international scale.

Curriculum↗
PubMed1999

Frontiers of finance: evolution and efficient markets.

In this review article, we explore several recent advances in the quantitative modeling of financial markets. We begin with the Efficient Markets Hypothesis and describe how this controversial idea has stimulated a number of new directions of research, some focusing on more elaborate mathematical models that are capable of rationalizing the empirical facts, others taking a completely different tack in rejecting rationality altogether. One of the most promising directions is to view financial markets from a biological perspective and, specifically, within an evolutionary framework in which markets, instruments, institutions, and investors interact and evolve dynamically according to the "law" of economic selection. Under this view, financial agents compete and adapt, but they do not necessarily do so in an optimal fashion. Evolutionary and ecological models of financial markets is truly a new frontier whose exploration has just begun.

Economics↗
PubMed1995

From futility to triage.

Basic disagreements about what makes human life valuable hinder use of the concept of futility to decide whether it is appropriate to continue life support for one in a permanent state of unconsciousness, or to provide intensive medical care to one in the last stages of a terminal illness (the "paradigm cases"). Triage planning (the process of establishing criteria for health care prioritization) is an attractive alternative framework for addressing the paradigm cases. Triage planning permits society to see the cases in the context of diverse moral perspectives, limited resources, and competing health care demands. Furthermore, at least one essential question posed by the paradigm cases is whether treatment is wasteful, and triage planning is a useful model for identifying and eliminating wasteful medical care. The authors describe how triage planning can be implemented to address the paradigm cases, and conclude that it offers one way of moving debate about these cases beyond futility.

Consensus↗
PubMedDate not supplied

Development and validation of a derived measure of research utilization by nurses.

BACKGROUND: Theoretical models are needed to guide strategies for the implementation of research into clinical practice. To develop and test such models, including analyses of complex theoretical constructs and causal relationships, rich datasets are needed. Working with existing datasets may mean that important variables are lacking. OBJECTIVE: The aim of this study was to derive a nursing research utilization variable and validate it using the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework on research implementation. METHODS: This study was based on data from two surveys of registered nurses. The first survey (1996; N = 600) contained robust research utilization variables but few organizational variables. The second (1998; N = 6,526) was rich in organizational variables but contained no research utilization variables. A linear regression model with predictors common to both datasets was used to derive a research utilization variable in the 1998 dataset. To validate these scores, four separate procedures based on the hypothesis of a positive relationship between context and research utilization were completed. Mutually exclusive groups reflecting various levels of context were created to accomplish these procedures. RESULTS: The derived research utilization variable was successfully mapped onto the cases in the 1998 dataset. The derived scores ranged from 0.21 to 21.40, with a mean of 10.85 (SD = 3.23). The mean score per subgroup ranged from 8.28 for the lowest context group to 12.75 for the highest context group. One of the validation procedures showed that significant differences in mean research utilization existed only among four conceptually unique context groups (p < .001). These groups showed a positive incremental relationship in research utilization (p < .001; the better the context, the higher the research utilization score). The validity of the derived variable was supported by using the three remaining validation procedures. DISCUSSION: The successful creation and validation of a derived research utilization variable will enable advanced modeling of the relationships between research utilization and individual and organizational characteristics. The findings also support the construct validity of the context element of the PARIHS theoretical framework.

Adult↗
PubMed2006

The motivation to care: application and extension of motivation theory to professional nursing work.

PURPOSE: The purpose of this research is to describe a model of nurses' work motivation relevant to the human caring stance of professional nursing work. DESIGN/METHODOLOGY/APPROACH: The model was derived from selected theories of behavioral motivation and work motivation. Evidence-based theory addressing nurses' work motivation and nurses' motivational states and traits in relation to characteristics of organizational culture and patient health outcomes is suggested in an effort to make a distinct contribution to health services research. An integrated review of selected theories of motivation is presented, including conceptual analyses, theory-building techniques, and the evidence supporting the theoretical propositions and linkages among variables intrinsic to nurses' work motivation. FINDINGS: The model of the Motivation to Care for Professional Nursing Work is a framework intended for empirical testing and theory building. The model proposes specific leadership and management strategies to support a culture of motivational caring and competence in health care organizations. ORIGINALITY/VALUE: Attention to motivation theory and research provides insights and suggests relationships among nurses' motivation to care, motivational states and traits, individual differences that influence nurses' work motivation, and the special effects of nurses' work motivation on patient care outcomes. Suggestions for nursing administrative direction and research are proposed.

Health Services↗
PubMed2006

Establishing a definition for a nurse-led clinic: structure, process, and outcome.

AIM: This paper reports a study to define a nurse-led clinic by exploring the domains of structure, process and outcome. BACKGROUND: Nurse clinics have been introduced as a measure to support intermediate care after the acute phase of disease. Previous studies have been mainly descriptive, or have only addressed a particular aspect of clinic service. METHODS: This exploratory study was conducted in two phases. In the first phase, nurses from 34 clinics were interviewed. In the second phase, 162 clinic sessions were observed, and 162 patients and 16 physicians were interviewed. The data were collected in 2001-2003. RESULTS: The nurses who ran the clinics were very experienced, and resources were available to support their work. Over 80% of their work was independent or interdependent, involving skills such as adjusting medications, and initiating therapies and diagnostic tests according to protocols. The principal interventions were assessments and evaluations, and health counselling. The nurses rated 'management of symptoms', 'prevention of complications', and 'client satisfaction' as the top three key indicators of their success. All patients studied showed improvement after the nurse clinic consultation, but the best rates were found in wound and continence clinics. Satisfaction scores for both nurses and clients were high. Physicians valued their partnership in care with the nurses, but were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. CONCLUSIONS: A nurse clinic is an effective alternative model of ambulatory healthcare delivery that uses a holistic framework.

Ambulatory Care↗
PubMed1991

From Freud to cognitive science: a contemporary account of the unconscious.

We present an account of two influential approaches to the unconscious; those of Freud and of cognitive science. It is argued that although Freud's ideas require updating in some respects, in other ways many of them have stood the test of time. We describe the similarities and differences between the two approaches and the attention each pays to innate cognitive and emotional competencies. Finally, we provide a contemporary cognitive account of the unconscious that attempts to combine the best both approaches within an information-processing framework.

Awareness↗
PubMed2026

Genome mining of alkaliphilic cyanobacterial consortia: identification of biosynthetic gene clusters in Sodalinema and associated heterotrophs.

Alkaline soda lakes are high-pH environments that host specialized microbial communities with potential for biotechnology and natural product discovery. We characterized three Sodalinema-dominated cyanobacterial consortia enriched from Canadian soda lakes over 510 days. Using hybrid metagenomic sequencing and metatranscriptomics across pH, alkalinity, and temperature gradients, we reconstructed high-quality metagenome-assembled genomes and assessed functional activity. All consortia converged toward cyanobacteria dominance and exhibited temperature optima between 21&#xb0;C and 30&#xb0;C. Phylogenetic analysis placed Sodalinema genomes within a distinct clade affiliated with Candidatus Sodalinema alkaliphilum. Genomic analysis indicated complete biosynthetic pathways for vitamin B5, vitamin B7, and the molybdenum cofactor, but incomplete pathways for vitamins B1, B9, and B12, consistent with patterns observed in Sodalinema yuhuli. Metatranscriptomic profiles showed increased expression of genes involved in phycocyanin and carotenoid biosynthesis at pH 10.2 relative to pH 8.5. Biosynthetic gene cluster analysis revealed that most secondary metabolic potential resided in heterotrophic community members. Roseinatronobacter encoded pathways for N-acyl homoserine lactones, osmoprotectants, betalactones, and prodigiosin, while Alkalimonas, Wenzhouxiangella, and members of the Kiloniellales encoded clusters for lanthipeptides, cyclodipeptides, hydrogen cyanide, and pyrroloquinoline quinone. These findings indicate functional partitioning within the consortia and highlight the contribution of heterotrophs to secondary metabolism.IMPORTANCEAlkaline soda lakes contain microbial communities adapted to high pH that remain underexplored for biotechnology. This study focuses on Sodalinema, a filamentous cyanobacterium that dominates enriched consortia from Canadian soda lakes, and its associated heterotrophic partners. We show that while Sodalinema drives primary productivity, heterotrophic bacteria encode most of the pathways for antimicrobial and signaling compounds. These interactions may support community stability and defense against competing microorganisms. By linking genomic potential with gene expression, this work identifies alkaline cyanobacterial consortia as a source of bioactive compounds and provides a framework for exploring extremophilic microbial communities for natural product discovery.

Sodalinema↗
PubMedDate not supplied

Participant satisfaction with a culturally appropriate diabetes education program: the Native American Diabetes Project.

PURPOSE: The purpose of this paper is to report on participant satisfaction with the Native American Diabetes Project diabetes education program. METHODS: A questionnaire was designed to measure satisfaction among participants in the diabetes education program, which consisted of five sessions designed according to the Transtheoretical Model of Change and Social Action Theory with input from community members. Eight pueblo communities participated in the program. Sessions were taught by community mentors in three sites in New Mexico. One site taught sessions in a one-on-one format, and two sites taught sessions in a group format. RESULTS: The results showed that participant satisfaction did not vary based on session delivery type or by session site. Overall, participants responded positively to sessions designed according to Social Action Theory and with cultural competency. Retention rates for the sessions were 81% for group sessions and 91% for one-one-one sessions. CONCLUSIONS: Using a strong theoretical framework and community input to design diabetes education sessions may be important factors in participant satisfaction and retention in diabetes lifestyle education sessions.

Diabetes Mellitus↗