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Results for “Competency framework”

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PubMedDate not supplied

Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.

The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.

Adult↗

PubMed1999

Normativity, guardianship, and the elderly. Some lessons from Canadian legislation.

The concept of guardianship, its associated principles, distinctions, and articulation of the legal needs of the elderly are introduced via a review of well-canvassed criticisms of Canadian guardianship legislation. Claims that the reformed legislation of Alberta, Quebec, and British Columbia represent models of adequate adult guardianship compared with traditional (archaic lunacy) law are examined. This paper argues that these renovated models exhibit a dubious normative advance over traditional legislation. Specifically, the normative presuppositions of the reformed legislation, such as, restriction to an autonomy-paternalism framework, and the norms of the liberal individual and state, obscure important issues in at least two key areas which challenge the models' assumptions; namely, assessment and legal competence and assessment and need. The development of guardianship laws and of social arrangements that are more responsive to the life experiences of the elderly requires critical re-articulation of the nature of individuals and their communities.

Adult↗

PubMedDate not supplied

Stochastic cost-effectiveness analysis: a simultaneous marginal-effect approach.

OBJECTIVE: The purpose of this study is to develop a cost-effectiveness methodology in the context of a simultaneous modeling framework that provides consistent point and interval estimates. METHODS: A simultaneous model of cost and effectiveness functions was developed to measure the incremental cost-effectiveness ratio for competing medical interventions. A feasible nonlinear least-squares method was suggested to estimate the simultaneous model. Using a series of hypothetical data, a simulation analysis was performed to show the superior performance of the proposed model, relative to the average-effect model, a widely used approach to cost-effectiveness estimation. RESULTS: The traditional average-effect approach has two shortcomings. First, it assumes two strong conditions: truly random distributions of all the significant nontreatment variables (both observed and unobserved) across study groups, and the independence of cost and effectiveness variables. Second, it does not give the confidence interval, an important measure to assess the stochastic nature and robustness of point estimates. In contrast, the simultaneous modeling approach provides marginal-effect estimates, imposing no restrictions on the random distributions of the individual characteristics across study groups. Furthermore, it takes into account the simultaneity of cost and effectiveness functions being estimated. The simulation analysis showed that the simultaneous modeling approach is significantly more unbiased and efficient in predicting the true cost-effectiveness ratio. CONCLUSION: The simultaneous modeling approach is superior to the average-effect approach in the estimation of incremental cost-effectiveness ratios using data with significant nontreatment confounding factors. The advantages of the simultaneous modeling approach are particularly appealing for evaluative studies dealing with large-scale retrospective data at the patient level.

Journal Article↗

PubMed2000

Tel-eNurse Practice: a practice model for role expansion.

RNs are expanding their role in the continuum of care, incorporating telecommunication into their practice to provide efficient and effective patient care. However, role expansion requires the definition and articulation of nursing practice and related outcomes. The Tel-eNurse Practice Model is a theoretical framework nurses can use to define and guide the complex process of care in the telephone encounter. Application of the model gives nurse administrators a way to identify competencies and develop standards of practice and quality and outcomes measurement tools.

Decision Making↗

PubMedDate not supplied

Cultural nursing care: the planning, development, and implementation of a learning experience.

"Cultural diversity" is a nursing education buzz word. Many facilities are adding cultural care competencies and learning experiences to the orientation curriculum. Designing a program to assist nurses to increase their knowledge of cultural issues should be based on a solid theoretical framework and adult learning theories in order to promote a higher level of critical thinking. In this article, the author explains the planning, development, and implementation of such a learning experience.

Adult↗

PubMed2006

Improving global health care through diversity.

One of the major challenges facing the nursing profession is the globalization of nursing education, research, and practice. The word diversity is derived from the Latin word divertere meaning being different or having differences. Diversity in nursing practice means providing competent care to clients from different cultures, conducting research in multi-cultural settings, and implementing educational programs to diverse populations. Key principles and practices that provide a framework for diverse relationships in nursing practice, research, and education must be driven by a professional commitment in building a global community that is inclusive, respectful, and dedicated to global health care for all. Through international collaborations and individual and collective partnerships, nurses can build bridges between and among national health care systems, strengthen the international health care infrastructure, broaden health care delivery systems, and improve the quality of health care for all.

Cooperative Behavior↗

PubMed2026

Research progress on multi-mechanism analysis and protection strategies of ovarian aging and fertility decline.

Age-related fertility decline is an increasingly important challenge in reproductive medicine, driven largely by progressive ovarian aging. The aging ovary undergoes functional deterioration characterized by reduced ovarian reserve and declining oocyte quality, ultimately limiting female reproductive lifespan. Although multiple molecular and cellular processes associated with ovarian aging have been identified, these mechanisms are often discussed independently, limiting an integrated understanding of how they interact within the ovary. In this review, we propose an ovary-centered, multi-mechanistic framework to organize current evidence on ovarian aging and fertility decline. We discuss how genomic instability, telomere attrition, mitochondrial dysfunction, oxidative stress, chronic cellular stress responses, and alterations in ovarian signaling and microenvironmental homeostasis collectively contribute to follicle depletion and impaired oocyte competence. Particular emphasis is placed on signaling pathways involved in follicle activation and stress adaptation, including PI3K/AKT/mTOR, FOXO3, Hippo, and AMPK-Sirtuin networks, while acknowledging that many mechanistic relationships remain incompletely defined in physiological ovarian aging. Building on this integrative perspective, we further evaluate mechanism-oriented intervention strategies, including mitigation of cellular stress, metabolic and signaling modulation, optimization of the ovarian microenvironment, established fertility preservation technologies, and emerging exploratory approaches. By integrating current mechanistic and translational evidence, this review provides a conceptual framework for understanding ovarian aging and highlights future directions for evidence-based fertility preservation and reproductive health management in the context of aging.

Humans↗

PubMed2005

Adolescent motherhood and postpartum depression.

Adolescent mothers undergo unique personal and social challenges that may contribute to postpartum functioning. In this exploratory investigation completed within a risk and resilience framework, 149 adolescent mothers, ages 15 to 19, who participated in school-based teen parents' programs, completed measures of parental stress (social isolation and role restriction), maternal competence, weight/shape concerns, and depression. The sample was quite diverse, and no ethnic differences in base rate levels of the variables were detected. Regression analyses indicated that social isolation, maternal competence, and weight/shape concerns predicted unique variance associated with depression level. The findings are discussed in light of future work and the continued need to inform prevention and treatment programs for young mothers.

Adolescent↗

PubMed1984

The study of stress and competence in children: a building block for developmental psychopathology.

This article discusses the building blocks for a developmental psychopathology, focusing on studies of risk, competence, and protective factors. The current Project Competence studies of stress and competence are described, with particular attention to the methodology and strategies for data analysis. The authors present a 3-model approach to stress resistance in a multivariate regression framework: the compensatory, challenge, and protective factor models. These models are illustrated by selected data. In the concluding section, an evaluation of the project is offered in terms of future directions for research.

Achievement↗

PubMed2000

The American College of Medical Practice Executives' competency study.

This article is the first of two studies conducted by the American College of Medical Practice Executives (ACMPE) that examines the perceived roles of medical practice executives. (Founded in 1956, the American College of Medical Practice Executives is the professional development and credentialing arm of the Medical Group Management Association (MGMA)). This study asked groups of physicians and nonphysician administrators to identify the competencies and associated skills and knowledge for administering group practices in today's changing environment. Those surveyed included administrators who are Fellows in ACMPE and 795 physicians who comprise the Society of Physician Administrators of the Medical Group Management Association. The responses were examined through a framework provided by the Managed Care Process Model. In this model, the focus is on the administrative and clinical processes required by different levels of managed care market penetration. The model progresses from a focus on relatively traditional practice management functions to those activities that are more complex with a greater focus on the integration of both clinical and business processes aimed at the health of populations. The analysis of the perceived competencies indicated that while both executive types perceived the importance of managing the health of populations, that task is not yet being incorporated into their professional roles.

Attitude of Health Personnel↗

PubMed2005

Multidisciplinary post-registered education in child and adolescent mental health services.

This article describes a study conducted in England as part of the preparation work for the Children's Taskforce, looking at the training needs of specialist Child and Adolescent Mental Health Service (CAMHS) staff, and of primary care staff who work with children and young people. A survey of existing service provision and of training opportunities was conducted, and as a result a series of recommendations for future training needs within CAMHS are made. It includes the needs of the developing role of Primary Mental Health Workers (PMHWs) within this area in their crucial link position between primary and secondary services. The study is multi-disciplinary in nature, given that all CAMHS teams are provided by multi-professional workers. Since this work was undertaken the workforce development plans for future CAMHS have progressed under the Children's Taskforce, with the National Service Framework for Children being published in October 2004.

Adolescent↗

PubMed2005

A decision making approach to assessing critical appraisal skills.

Critical appraisal is an important skill for practicing evidence-based medicine. Most assessments of critical appraisal focus either on knowledge about research design or evaluate a written critique of an article. This paper presents a Bayesian framework for assessing critical appraisal through measuring how clinical decisions and judgments change with the introduction of new research evidence. In a skilled clinician-appraiser, new evidence is predicted to cause the clinician to revise beliefs in the appropriateness of a decision, in proportion to both the strength of the findings and the methodological soundness of the research which produced the findings. The framework is illustrated by two studies using different items, respondents, and designs.

Bayes Theorem↗

PubMed1991

Researching needs in district nursing.

This paper describes the first stage of a research project aimed at understanding the needs of clients (and their carers) of district nursing services. The project applies a pluralistic research design, combining qualitative and quantitative methods. Through the use of an ethnographic approach, concepts of needs are generated which are related to how clients and carers perceive themselves and the role of the district nurse. The study attempts to formulate needs within a contextual framework against which an activity analysis of district nurses' work (stage 2) can be evaluated.

Clinical Competence↗

PubMed2005

Developing essential professional skills: a framework for teaching and learning about feedback.

BACKGROUND: The ability to give and receive feedback effectively is a key skill for doctors, aids learning between all levels of the medical hierarchy, and provides a basis for reflective practice and life-long learning. How best to teach this skill? DISCUSSION: We suggest that a single "teaching the skill of feedback" session provides superficial and ineffective learning in a medical culture that often uses feedback skills poorly or discourages feedback. Our experience suggests that both the skill and the underlying attitude informing its application must be addressed, and is best done so longitudinally and reiteratively using different forms of feedback delivery. These feedback learning opportunities include written and oral, peer to peer and cross-hierarchy, public and private, thereby addressing different cognitive processes and attitudinal difficulties. SUMMARY: We conclude by asking whether it is possible to build a consensus approach to a framework for teaching and learning feedback skills?

Assertiveness↗

PubMed1984

A framework for assessing performance problems.

How do we as managers address problems of nonperformance ? Robert Mager and Peter Pipe provide a framework for identifying the real problem, deciding whether or not there is a skill deficiency, and whether performance is punishing or whether nonperformance is rewarding. If performance really matters, are there obstacles to performing? This framework helps us to analyze performance deficiencies systematically and to move toward an appropriate solution.

Clinical Competence↗

PubMed1996

The legal framework for effective competition.

Largely because of its indifference to spiraling costs, the professional domination model is being replaced by a market model based on competition among managed care plans and integrated delivery systems. In general, the more fully integrated previously competing providers become--for instance, by assuming financial risk together--the less legal risk is present, because of a decreased possibility of improper conspiratorial or collective behavior. Nevertheless, provider joint ventures and integrated delivery systems face a complex interaction of practical challenges and various legal and regulatory risks. This chapter explores ways in which laws involving fraud and abuse, self-referral, private inurement, corporate practice of medicine, Medicare reimbursement policy, and antitrust enforcement affect typical integrated delivery systems. From a legal standpoint, it might seem logical that the laws regulating health care providers would support and promote integration. A permissive legal environment to foster development of an integrated service network model assumes its development in a delivery system in which networks are at financial risk for the services provided. However, many of the laws and regulations governing integrated provider development were established at a time when joint ventures and other alliances were organizing in a predominantly fee-for-service environment and were generating significant increases in health care costs without producing demonstrable efficiencies or quality enhancements. The results is a fundamental inconsistency in government policy. The demand for collaboration by purchasers and legislatures does not necessarily cause the vast body of health care regulators to revise their concerns that many of the very collaborative activities being encouraged trigger potentially illegal acts and relationships. In a market model, the application of federal and state antitrust laws is especially important. In 1993 and 1994, the Department of Justice and the Federal Trade Commission jointly issued "Statements of Antitrust Enforcement Policy" in a number of areas of provider uncertainty. For integrated delivery systems, the primary focus of antitrust analysis is "market power." Systems without market power (i.e., the ability to force a purchaser to do something that the purchaser would not do in a competitive market) cannot harm consumers and should be free from serious antitrust risk. Where a network may have market power, its activities may be limited only if demonstrable anticompetitive effects outweigh the benefits of the efficiencies claimed by the new arrangement. The chapter concludes that vigorous antitrust enforcement may be required to promote market competition among integrated networks of providers and the managed care plans they serve.

Antitrust Laws↗

PubMed2006

The evolution of the emergency care practitioner role in England: experiences and impact.

BACKGROUND: The emergency care practitioner (ECP) is a generic practitioner who combines extended nursing and paramedic skills. The "new" role emerged out of changing workforce initiatives intended to improve staff career opportunities in the National Health Service and ensure that patients' health needs are assessed appropriately. OBJECTIVE: To describe the development of ECP Schemes in 17 sites, identify criteria contributing to a successful operational framework, analyse routinely collected data and provide a preliminary estimate of costs. METHODS: There were three methods used: (a) a quantitative survey, comprising a questionnaire to project leaders in 17 sites, and analysis of data collected routinely; (b) qualitative interpretation based on telephone interviews in six sites; and (c) an economic costing study. RESULTS: Of 17 sites, 14 (82.5%) responded to the questionnaire. Most ECPs (77.4%) had trained as paramedics. Skills and competencies have been extended through educational programmes, training, and assessment. Routine data indicate that 54% of patient contacts with the ECP service did not require a referral to another health professional or use of emergency transport. In a subset of six sites, factors contributing to a successful operational framework were strategic visions crossing traditional organisational boundaries and appropriately skilled workforce integrating flexibly with existing services. Issues across all schemes were patient safety, appropriate clinical governance, and supervision and workforce issues. On the data available, the mean cost per ECP patient contact is 24.00 pounds sterling, which is less than an ED contact of 55.00 pounds sterling. CONCLUSION: Indications are that the ECP schemes are moving forward in line with original objectives and could be having a significant impact on the emergency services workload.

Delivery of Health Care↗

PubMed2005

Quality evaluation in health care services based on customer-provider relationships.

PURPOSE: To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. DESIGN/METHODOLOGY/APPROACH: Systematic review of the literature. FINDINGS: Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). ORIGINALITY/VALUE: This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

Evaluation Studies as Topic↗