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PubMed1999

Collaboration, problem solving, reevaluation: foundation for the Heart Center of Excellence.

Today's rapidly changing health care environment has thrust upon the caregivers, patients, and their families many challenges. A multidisciplinary team continuously analyzes strengths, weaknesses, and threats to the success of heart centers. Prolonged hospitalization for cardiac surgery patients is consistently identified as a priority with multiple opportunities for improvement. All patients are monitored for variables known to impact length of stay including same day admission, intubation time, out of bed interval following extubation, and delay in postoperative transfer to the progressive cardiac care unit (PCCU). Utilizing collaboration, problem solving, and reevaluation, known as CPR techniques, postoperative intubation time, and the out of bed interval following extubation, have both dramatically decreased. Despite declines in elective, same day admissions and fewer first day postoperative transfers, length of stay following cardiac surgery has also declined. The continuum of patient care has been established from preadmission to postdischarge and up to one year following cardiac surgery. Utilizing CPR techniques allowed us to achieve a best practice model for successfully improving outcomes in heart centers.

Cardiac Surgical Procedures↗

PubMed1992

Planning and problem solving. Strategy for opening an oncology/chemotherapy unit.

The world-wide nursing shortage is resulting in institutions all over the world recruiting nurses from other countries with varying nursing skill levels and cultural backgrounds. The purpose of this article is to provide a framework for international institutions to adopt, to ensure continued quality care for oncology patients. At King Faisal Specialist Hospital & Research Centre (KFSH&RC) in Riyadh, Saudi Arabia, nurses have been recruited from over 25 different countries. Many of these nurses have never cared for oncology patients or given chemotherapy. A framework combining the strategies of planning and problem-solving was utilized to operationalize this unit in a multicultural setting. Cultural variants related to caring for Saudi patients by a multinational work force with differing cultural backgrounds as well as differing educational programs for nurses was reviewed in terms of their impact on staffing an oncology unit. An oncology/chemotherapy certification course was developed to document the competency of these multinational nurses to administer chemotherapy and to provide safe quality care to oncology patients.

Hospital Units↗

PubMed1985

Double dissociation between perseveration in memory and problem solving tasks.

This study reports a double dissociation between perseverative responses on a short-term verbal memory test and a card sorting task, as shown by two patients with cerebral tumours. The two patients were matched for number of correct responses on the memory task. The first patient, with a craniopharyngioma and associated dilatation of the third ventricle and lateral ventricles, showed perseveration on the short-term memory task but not on the card sorting task. The second patient, with a subfrontal tumour involving the anterior corpus callosum, perseverated on the card sorting task but not on the short-term memory task. The presence of this double dissociation demonstrates the functional specificity of perseveration in certain memory and problem solving contexts and suggests that distinct subcortical/frontal mechanisms may underly specific types of perseveration.

Amnesia↗

PubMed1997

Medical problem-solving: a five stage approach in primary medical care.

A methodology for a five stage or pentagonal problem-based approach to solve individual or family health-related problems is described. The model can be applied in health worker learning, student teaching or problem solving in the real world of the patient and his/ her family within the context of community health. The model stresses interdisciplinary co-operation, the consideration of ethical factors in each case, and a logical transition from individual patient care to community diagnosis and intervention. The model is applicable to any disease process, all levels of care, all levels of intervention and all clinical disciplines.

Community Medicine↗

PubMed2005

Ways of thinking about and teaching ethical problem solving: microethics and macroethics in engineering.

Engineering ethics entails three frames of reference: individual, professional, and social. "Microethics" considers individuals and internal relations of the engineering profession; "macroethics" applies to the collective social responsibility of the profession and to societal decisions about technology. Most research and teaching in engineering ethics, including online resources, has had a "micro" focus. Mechanisms for incorporating macroethical perspectives include: integrating engineering ethics and science, technology and society (STS); closer integration of engineering ethics and computer ethics; and consideration of the influence of professional engineering societies and corporate social responsibility programs on ethical engineering practice. Integrating macroethical issues and concerns in engineering ethics involves broadening the context of ethical problem solving. This in turn implies: developing courses emphasizing both micro and macro perspectives, providing faculty development that includes training in both STS and practical ethics; and revision of curriculum materials, including online resources. Multidisciplinary collaboration is recommended 1) to create online case studies emphasizing ethical decision making in individual, professional, and societal contexts; 2) to leverage existing online computer ethics resources with relevance to engineering education and practice; and 3) to create transparent linkages between public policy positions advocated by professional societies and codes of ethics.

Computer-Assisted Instruction↗

PubMed1993

Social goals: relationship to adolescent adjustment and to social problem solving.

Examined the relations between adolescent boys' social goals of dominance, revenge, avoidance, and affiliation and (1) self-reported negative adolescent outcomes; (2) subjective sense of self-esteem; and (3) externalizing, internalizing, and prosocial behaviors, as rated by peers and teachers. Results indicated that social goal values were related to diverse aspects of self-, teacher-, and peer-reported social and behavioral functioning, with a consistent association found between a range of delinquent, substance-using, and behavioral difficulties, and endorsement of high goal values for dominance and revenge and low goal values for affiliation. Results also indicated that teacher-identified aggressive boys differed from nonaggressive boys in the value they placed on social goals, with aggressive boys placing a higher value on goals of dominance and revenge, and lower value on goals for affiliation. Finally social goal choice had a clear relation to the social problem-solving differences of aggressive and nonaggressive boys.

Adolescent↗

PubMed1985

Effects of intoxication on alcoholics' marital communication and problem solving.

The effects of intoxication on the marital interactions of treatment-motivated alcoholics and their nonalcoholic spouses were studied in eight couples (two of which had an alcoholic wife). In half of the sessions, the alcoholics were given enough alcohol to reach a blood level of 10 mg/dl. Couples engaged in three 10-min conflict-resolution discussions of varying intensity counterbalanced for alcohol and no-alcohol sessions. Couples expressed significantly more positive verbalizations in the alcohol sessions than in the no-alcohol sessions. This was true especially for the nonalcoholic spouses, who doubled their rate of positive verbal behavior when interacting with an intoxicated partner. Alcoholics spoke more and tended to make more problem-describing statements while intoxicated than while sober. The alcoholics made a greater number of problem-solving statements than did their spouses. Alcoholics were significantly more negative and less positive in nonverbal behaviors than were their spouses, but neither self-report of marital satisfaction nor observations of verbal behavior reflected this. The models of both social-learning theory and systems theory for the relationship of marital factors to the etiology and maintenance of alcoholism are supported.

Adult↗

PubMed2005

Physicians ask for more problem-solving information to promote and support breastfeeding.

Physicians (n=262) were surveyed about their breastfeeding promotion practices, knowledge, and areas in which they need more information in order to be more influential with patients in the initiation and duration of the process. Over half (51%) reported no or limited education in breastfeeding, whereas only 9% reported adequate education. A knowledge assessment indicated almost half (42%) did not know certain viruses can be transmitted through breast milk. There were also mixed responses to the need for vitamin D supplementation. Promotion practices included most (82%) thinking the physician has a primary role in the feeding decision, and most did discuss the benefits with patients; however, only 54% would recommend breastfeeding to a patient who had decided to bottle-feed. Problem-solving was the main area physicians reported needing more education. Partnerships with dietetics professionals may fill the gaps in the support needed to increase rates of breastfeeding.

Adult↗

PubMed2006

fMRI study of problem-solving after severe traumatic brain injury.

OBJECTIVE: To assess the cerebral correlates of the dysexecutive syndrome after diffuse severe traumatic brain injury (TBI). METHODS: Ten patients with sub-acute/chronic severe TBI without detectable focal cortical contusion and 11 matched healthy subjects were included in a parametric fMRI study using a planning task, the Tower of London. RESULTS: Brain activation in the left Dorsolateral Pre-frontal Cortex (DLPFC) and the Anterior Cingulate Cortex (ACC) was closely related to performance. Patients with TBI who performed the task efficiently showed, like healthy controls who obtained a similar pattern of performance, a large activation in the left DLPFC and a small activation in the ACC. In contrast, poor performance was associated with a reduced activation in these both regions. CONCLUSION: Problem-solving deficits after severe diffuse TBI could be related to an impaired activation of the DLPFC and of the ACC.

Adolescent↗

PubMed1996

Solving problems by analogy: the benefits and detriments of hints and depressed moods.

In Experiment 1, mildly depressed (dysphoric) and nondysphoric subjects tried to solve logic problems that were analogous to subsequent target problems; then they attempted target solutions with or without hints in the form of the anologues' themes. Target solutions were impaired by the hints in the nondysphoric group alone. Experiment 2A was a no-training control to verify that transfer did indeed occur. In Experiment 2B, all subjects received hints in the transfer phase; the training phase was either problem oriented (as in Experiment 1) or memory oriented. Again, nondysphoric subjects solved fewer problems following problem-oriented training than did both dysphoric subjects in that condition and nondysphoric subjects with memory-oriented training. Experiment 3 replicated the previous results in the nondysphoric samples. We interpret these findings within the transfer-appropriate processing framework.

Adult↗

PubMed1994

Effective use of a common problem-solving process as an integral part of TQM.

Many organizations implement TQM programmes, but it is estimated that only 25 per cent of them can be classified as successful in terms of delivering the benefits that should be expected from them. Failure to create the conditions through systems and procedures which highlight problems in the organization and provide common approaches to solving them (such as an "in-company" problem-solving process) is often a main reason for such a low success rate. The benefits of successfully implementing the extensive use of a common problem-solving process and adopting a management style at all levels that supports, allows and encourages employees to use it are enormous. The problem-solving process should be an integral part of the TQM initiative and supported by ongoing training and facilitation, and used by management at all levels.

Humans↗

PubMed2000

Regulation of negative affect during mother-child problem-solving interactions: adolescent depressive status and family processes.

Despite recent suggestions that depression can be conceptualized as a disorder of affect regulation, relatively little research has focused on affect regulation skills in depressed individuals. This paper investigated whether depressed adolescents (N = 25) differ from nondepressed adolescents (N = 25) on two indices of affect regulation (i.e., duration of negative affective states and reciprocity of maternal negative affect) as well as whether these indices are related to microsocial family interactional processes. Analyses revealed that depressed teens differed from their nondepressed peers with regard to duration of negative affective states but not in their likelihood of reciprocating negative affect. Additionally, indices of adolescent affect regulation were related to family interactional processes. Duration of depressive affect was positively associated with maternal display of facilitative behavior contingent on adolescent depressive behavior. Duration of aggressive behavior was inversely related to maternal problem-solving responses to aggressive behavior. Finally, adolescent reciprocity of maternal depressive and aggressive behaviors was strongly associated with mothers' reciprocity of adolescents' negative affective behavior.

Adolescent↗

PubMed1993

Removal of an obstacle: Problem-solving behavior in pigeons.

The importance of a subject's personal history in the solution of an obstruction problem was demonstrated with pigeons. Four birds were trained to peck a key located outside the chamber by poking their heads through an opening in a screen. During tests, a white block was placed in front of the opening, so that it was not possible to peck the key without removing the block. All birds failed to remove the block. However, all birds that were subsequently trained to push the white block around the chamber in the absence of the key and a few of the birds trained similarly but with a black block solved the problem by pushing the block aside and pecking the key. One bird showed the abrupt descent in the learning curve that has been considered a characteristic of "insightful" problem solving. All birds maintained their successful performance after a 1-month interval with no intervening tests.

Journal Article↗

PubMed1996

Communication patterns and alliances between parents and adolescents during a structured problem-solving task

The influence of gender on communication patterns and reciprocal alliances was observed within the context of a controlled problem-solving task. Participants included 20 adolescent boys and 20 adolescent girls with their parents. The study found that families with boys engaged in more active bargaining than families with girls. Sons made offers for alliances to mothers at almost twice the rate of daughters. Also, adolescent gender may influence communication between mothers and fathers. Mothers seem particularly influenced by the gender of their adolescent, and adolescents appear to be influenced by whether they are interacting with their mother or father.

Journal Article↗

PubMed1990

[The development of spatial problem solving ability in early blind].

Thirty-one pupils at elementary schools (ages between six years and nine month and 12 years and two months) and seven adults were tasted using the method developed by Yamamoto and Tatsuno (1984) to investigate the development of spatial ability in the early blind. The subjects walked, with the guidance of the experimenter, on a path which had 45, 90, or 135 degree right or left angle turn at its middle point. At the end point of each path, the subjects walked back alone to find the starting point of the path. The trials were repeated 12 times. The adult group made less angular error in the direction of movement when they walked back alone, though other performance measures scarcely showed any indications of development of the ability. The subjects' verbal reports concerning their problem solving methods revealed that many of them were using the starting point as an anchor while they were walking. The data obtained were evaluated with reference to the earlier data for the sighted [Yamamoto & Tatsuno's (1984) data]. Some points of agreement and disagreement with the argument of put forward by Juurmaa (1973) and the present results concerning the development of spatial ability, were also discussed.

Adolescent↗

PubMedDate not supplied

Tower of Hanoi and WCST performance in schizophrenia: problem-solving capacity and clinical correlates.

We administered a computerized version of WCST, a well established test, sensitive to executive function deficits in schizophrenia that involves many features of cognitive processing, and of Tower of Hanoi, a test that may offer cognitive challenges more specifically related to planning and sequencing, to 28 schizophrenic patients and 28 matched controls to examine a worthwhile question regarding the relative ability of these two tasks to differentiate schizophrenia and normal groups as well as exploring the relationship of these two instruments to clinical variables. The schizophrenic patients performed significantly worse than normal subjects both on Tower of Hanoi test and on WCST. The discriminant analysis identified in a multivariate way a pattern of indexes that differentiate the two groups. This pattern, characterized by specific indexes of WCST and TOH, could suggest the existence of a common underlying factor that determines the cognitive impairment in problem-solving of schizophrenics. These findings and the relationship with positive and negative symptoms have been discussed in the light of the model of the impairment in the internal representation of context information.

Adult↗

PubMed1990

Can communication deviance be measured in a family problem-solving interaction?

Communication deviance (CD) refers to confusing and fragmented communication that prevents family members from attaining a shared focus of attention and meaning. Levels of communication deviance based on individual parental projective test protocols--Thematic Apperception Test (TAT) and Rorschach--have repeatedly been found to be higher in parents of schizophrenic offspring than in parents of normal or nonpsychotic offspring. CD has also been measured in family transactions in which parents and their offspring interact with one another around a projective test stimulus, the Consensus Rorschach. There have been relatively few attempts to measure specific CD codes in familial interaction that is not initiated around an ambiguous visual stimulus. The present article examines the reliability and construct validity of an interactional measure (ICD) obtained from family transactions in which parents and patients are working toward the solution of a salient family problem. ICD from this family problem-solving task was compared to more traditional measures of CD from parental TAT protocols in a sample of 59 parents of 37 recent-onset schizophrenic patients. Results indicated that CD could be reliably measured in an interactive setting not initiated around a projective test stimulus, and provided evidence for the construct validity of ICD.

Adolescent↗

PubMed2005

Characteristics of fluent skills in a complex, dynamic problem-solving task.

We examined critical characteristics of fluent cognitive skills, using the Georgia Tech Aegis Simulation Program, a tactical decision-making computer game that simulates tasks of an anti-air-warfare coordinator. To characterize learning, we adopted the unit-task analysis framework, in which a task is decomposed into several unit tasks that are further decomposed into functional-level subtasks. Our results showed that learning at a global level could be decomposed into learning smaller component tasks. Further, most learning was associated with a reduction in cognitive processes, in which people make inferences from the currently available information. Eye-movement data also revealed that the time spent on task-irrelevant regions of the display decreased more than did the time spent on task-relevant regions. In sum, although fluency in dynamic, complex problem solving was achieved by attaining efficiency in perceptual, motor, and cognitive processes, the magnitude of the gains depended on the preexisting fluency of the component skills. These results imply that a training program should decompose a task into its component skills and emphasize those components with which trainees have relatively little prior experience. Actual or potential applications of this research include learning and training of complex tasks as well as evaluation of performance on those tasks.

Aviation↗