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Results for “Competency framework”

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PubMed2005

Semiparametric proportional odds models for spatially correlated survival data.

The last decade has witnessed major developments in Geographical Information Systems (GIS) technology resulting in the need for statisticians to develop models that account for spatial clustering and variation. In public health settings, epidemiologists and health-care professionals are interested in discerning spatial patterns in survival data that might exist among the counties. This paper develops a Bayesian hierarchical model for capturing spatial heterogeneity within the framework of proportional odds. This is deemed more appropriate when a substantial percentage of subjects enjoy prolonged survival. We discuss the implementation issues of our models, perform comparisons among competing models and illustrate with data from the SEER (Surveillance Epidemiology and End Results) database of the National Cancer Institute, paying particular attention to the underlying spatial story.

Bayes Theorem↗

PubMed2000

Ethological confirmatory factor analysis of anxiety-like behaviour in the murine elevated plus-maze.

The elevated plus-maze has been used in animal research to measure anxiety since 1985 and is currently the most widely used animal model of anxiety. Since this paradigm has been the subject of several principal components analyses, it is well qualified for confirmatory factor analysis research. The current report builds on the substantial theoretical knowledge and empirical data obtained from these structural analyses with a view to obtain further progress in the evolution of our understanding of animal anxiety in the elevated plus-maze. The purpose of the present report was two-fold: (a) to test if the a piori imposition of a 3-factor model, or a competing 2-factor elevated plus-maze model, would fit our sample (n=200 CD-1 mice) data in each of two trials within an inferential confirmatory factor analytic framework; (b) provide a well-fitting model that confers indicator variables that can most effectively and parsimoniously measure underlying constructs of elevated plus-maze behaviour. Multiple model-fitting criteria were used, and issues related to data non-normality, outliers, replicability of the model, sampling error and error of approximation in the estimation of final model fit were addressed. The final 2-factor model, with estimated error covariance between two different pairs of indicator variables, was a good fit on the trial-1 data, although it was necessary to allow unprotected stretch attends to non-significantly cross-load on factor-2. A 2-factor model also fit the trial-2 data from the present analysis, although it was necessary to allow closed arm time ratio to negatively cross-load on factor-1. These results indicate that inferential hypothesis testing and model building procedures within a confirmatory factor analysis framework produces interpretable animal anxiety indices in the elevated plus-maze. Moreover, a 2-factor, rather than a 3-factor model, parsimoniously and unambiguously explained the underlying constructs of anxiety-like mouse behaviour in the elevated plus-maze in the present study. Taken together, a reduction in the growing number of behavioural indices reported in elevated plus-maze pharmacological studies is suggested.

Animals↗

PubMed1986

Relation of intelligence to ego functioning in an adult psychiatric population.

Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQs and clinical ratings of 10 ego functions in a diagnostically heterogeneous sample of 60 adult psychiatric inpatients were correlated. With severity of pathology statistically controlled, higher intelligence was associated with more adequate ego functioning in several spheres: primary autonomous functions, thought processes, object relations, and mastery-competence. There were also some clinically meaningful differences between the Verbal and Performance IQs in the pattern of correlations. Extending Hartmann's original views, the authors employ an ethological framework to conceptualize intelligence in relation to the ego's role in adaptation, emphasizing that intelligence is an important-albeit neglected-aspect of ego functioning.

Adult↗

PubMed1997

Enhancing teamwork in complex environments through team training.

Although the importance of team training has become widely recognized, research is needed to more clearly understand what instructional strategies actually lead to enhanced teamwork and performance. This research incorporates a theoretical framework, based on the work of J.A. Cannon-Bowers, S.I. Tannenbaum, E. Salas, and C.E. Volpe (1995), to guide the systematic development of training that targeted specific team competencies (i.e., knowledge, skills, and attitudes). The theoretically designed training was delivered to 42 male aviators from an undergraduate naval aviation community. A comprehensive evaluation of this training was conducted using a multiple-measurement approach. Results provide strong support for the effectiveness of this team training in improving critical team competencies.

Aerospace Medicine↗

PubMedDate not supplied

[Counseling concerning prenatal diagnosis and possible handicap: psychosocial viewpoint].

Before the background of today's routine of carrying out prenatal examinations, this study focuses on two aspects in particular: The women's experiences in the decisive conflict when making use of prenatal diagnostics as well as the psychosociological framework conditions at the time of their decision making. In this context, the paper explains more the basics profile of psychosociological advice, present the requirements to the qualification and competence of the advisers and examines the structural conditions concerning the existing legal claim to advice.

Abortion, Eugenic↗

PubMed1987

Implementation of nursing diagnoses in nursing education.

Successful implementation of nursing diagnosis in nursing education begins with assessment of the program's philosophy, terminal objectives, faculty, and organizational framework. The outcome of successful implementation is a graduate that uses nursing diagnosis as the pivotal point in nursing practice. If nurses of today and tomorrow are to become competent diagnosticians in nursing, teaching diagnostic reasoning and nursing diagnosis formulation must be an integral part of the nursing educational process.

Curriculum↗

PubMedDate not supplied

"Of mind, body, and spirit": therapeutic foster care--an innovative approach to healing from an NTU perspective.

This article examines Progressive Life Center's (PLC) innovative Therapeutic Foster Care (TFC) program, and its incorporation of a unique clinical approach, NTU (pronounced in-to) psychotherapy, into its program model. PLC is an African American private nonprofit community-based organization that strives to improve the delivery of mental health services through culturally competent therapeutic techniques. PLC expanded its services to include TFC for seriously emotionally disturbed children, ages 2 to 18. All PLC services are delivered within the spiritual and cultural framework of NTU.

Adolescent↗

PubMed1996

Hospital middle managers' perceptions of their work and competence.

Middle managers in acute care hospitals in New England rated the importance of most work roles and skills higher than their competence to perform them. Being male, having a bachelor's or graduate degree, and reporting to a vice president were related to higher competence ratings for some roles and skills while having held a clinical position in the same organization was related to lower ratings. Middle managers rated skills and roles focused on their individual work units as more important than those associated with their organizations or external environments. This framework for categorizing work may be useful in identifying education, institutional support, or work redesign that would assist middle managers in being more effective.

Communication↗

PubMed2006

Situated cognition and cognitive apprenticeship: a model for teaching and learning clinical skills in a technologically rich and authentic learning environment.

The acquisition of a range of diverse clinical skills is a central feature of the pre-registration nursing curriculum. Prior to exposure to clinical practice, it is essential that learners have the opportunity to practise and develop such skills in a safe and controlled environment under the direction and supervision of clinical experts. However, the competing demands of the HE nursing curriculum coupled with an increased number of learners have resulted in a reduced emphasis on traditional apprenticeship learning. This paper presents an alternative model for clinical skills teaching that draws upon the principles of cognitive apprenticeship [Collins, A., Brown, J.S., Newman, S., 1989. Cognitive Apprenticeship: teaching the crafts of reading, writing and mathematics. In: Resnick, L.B. (Ed.) Knowing. Learning and Instruction: Essays in Honor of Robert Glaser. Lawrence Erlbaum Associates, New Jersey, pp. 453-494] and situated cognition within a technologically rich and authentic learning environment. It will show how high quality DVD materials illustrating clinical skills performed by expert practitioners have been produced and used in conjunction with CCTV and digital recording technologies to support learning within a pedagogic framework appropriate to skills acquisition. It is argued that this model not only better prepares the student for the time they will spend in the practice setting, but also lays the foundation for the development of a clinically competent practitioner with the requisite physical and cognitive skills who is fit for purpose [UKCC, 1999. Fitness for Practice: The UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing Midwifery and Health Visiting, London].

Attitude of Health Personnel↗

PubMedDate not supplied

Differentiating between a consultant nurse and a clinical nurse specialist.

With the introduction of nurse consultants, and regulation of the use of the designation 'specialist nurse', experienced practitioners such as clinical nurse specialists have seen their position eroded. Nurse consultants are a new NHS-employment category, and are expected to be at the top rank of the profession both in status and in salary. However, this article argues that nurses at various levels have the same core functions, and that these do not differ for nurse consultants. Distinguishing between practitioners that might have the same job description could be better done by measuring outcomes. More care needs to be taken over the use of words such as 'expert', which is used differently in different contexts, and it is suggested that competencies be developed by which to measure the effects of expertise. Although nurse consultant appointments are often driven by various political directives and they are employed to meet local and national priorities, difficult issues need to be faced. First, if nurse consultant jobs are the top of the clinical career ladder, will clinical nurse specialists (CNSs) need to accept a lower rung on it? Further, perhaps the title CNS should become obsolete or be regulated? Can CNSs claim parity of pay using the 'Agenda for Change' framework?

Attitude of Health Personnel↗

PubMed2005

Selection of a macaque Fab with framework regions like those in humans, high affinity, and ability to neutralize the protective antigen (PA) of Bacillus anthracis by binding to the segment of PA between residues 686 and 694.

Human anthrax infection cannot always be treated successfully by antibiotics, as highlighted by recent bioterrorist attacks; thus, adjunct therapies are clearly needed for the future. There is a particular need to further develop adjunct therapies that can neutralize secreted toxins, such as antibodies directed towards the 83-kDa protective antigen (PA(83)). In the absence of human donors, we immunized a macaque (Macaca fascicularis) with PA(83) to obtain such antibodies suitable as an adjunct therapy for human anthrax infection. By using bone marrow as a template, we PCR amplified specific Fab-encoding genes and cloned them as an immune library (10(7) clones). We isolated a high-affinity (equilibrium dissociation constant [K(D)], 3.4 nM), highly neutralizing (50% inhibitory concentration, 5.6 +/- 0.13 nM) Fab (designated 35PA(83)) from this library by panning. Its epitope was localized by Pepscan analysis between residues 686 and 694 of PA(83) and is part of the region which directly interacts with the cell receptor. 35PA(83) may thus neutralize the anthrax toxin by competing directly for its receptor. The genes encoding 35PA(83) were similar to those of a human immunoglobulin germ line and were assigned to subgroups of human V, (D), or J genes by IMGT/V-QUEST analysis. The 35PA(83) framework regions were 92% identical to a representative allele of each subgroup. When compared to framework regions coded by related human germ line genes, only 2 of 74 (VH) or 75 (VK) analyzed amino acids of 35PA(83) have different chemical characteristics. A very high degree of identity with human framework regions makes 35PA(83) well suited for expression as a whole primatized immunoglobulin G and demonstrates the practicality of using macaque Fabs when immunized human plasma cell donors are not available.

Amino Acid Sequence↗

PubMed1986

Marital context and post-infarction quality of life: is it social support or something more?

The development of a theory of quality of life following serious illness is currently an important field of endeavour in rehabilitation research. The interpersonal relationships of people and elements of the self-concept appear to be salient factors in causal models of subjective well-being. One such model developed to explain characteristic levels of well-being was used in a longitudinal study of adaptation to a first myocardial infarction. Data were collected from a national sample of male cardiac patients and their spouses on the illness and marital situation as predictors of long-term well-being or ill-being. Analyses of data from the first three waves of the study, which is to extend over 5 years after the onset of illness, are to be discussed in the paper. Marital status, the emotional quality of the spouse relationship and long-standing marital stressors were found to have direct and indirect effects on the two dimensions of the Bradburn Affect Balance Scale. The same is true of continuing problems associated with the heart attack relative to perceptions of having coped effectively with the after effects of illness. Differences in self-esteem and personal competence were suggested as mediators of socio-environmental and illness-related influences. The two-factor conception of well-being developed was found to be a useful framework for investigating positive and negative aspects of psychosocial rehabilitation. The same factors that explain differences between happy and unhappy people in social indicators research also appeared to be determinants of different trajectories of adaptation in the wake of a life-threatening illness. Previous research using theoretical models from stress research has overemphasized psychosocial morbidity and stress management and neglected positive processes of adaptation. The identification of love resources related to positive feeling states and life satisfaction has, therefore, not received the attention it deserves. This is especially the case regarding an overemphasis of the concept of social support as a buffer of stress. Instruments were developed to measure high and low marital intimacy, as well as chronic marital role strains, and these measures appeared to explain different trajectories of adjustment to cardiac disease. The two-factor model appears to be useful for future work on quality of life with chronic illness. The same is true of four marital contexts of rehabilitation that were identified in the study.

Adaptation, Psychological↗

PubMed1994

A comparative study of patient satisfaction with health care in Japan and the United States.

Patient satisfaction with medical care received at selected medical facilities in the United States (895 patients) and in Japan (856 patients) was compared using self-administered questionnaires. In each country, patients at a large government hospital and a smaller affiliated clinic were surveyed. Patients responded to questions concerning specific aspects of medical care, general satisfaction with the care received, waiting time to see the physician and time spent with the physician. Results suggest that patients at study sites in both countries were generally satisfied with the medical care they received. However, American patients were more likely to report satisfaction than their Japanese counterparts on each dimension of health care measured. The largest discrepancies were found in satisfaction with waiting time to see the doctor and time spent with the doctor. Stepwise discriminant analyses indicated that provider skill may be the most important predictor of overall satisfaction with medical care in both countries. These results are discussed in the framework of the underlying health care system.

Adult↗

PubMed2005

Sedation and patient safety.

The safety of patients receiving sedation and sedating analgesia therapies is a system property. There are multiple team members and processes needed to ensure safety that reside outside the purview of nursing. This article outlines safety considerations in sedation using the Eindhoven classification system as framework for aggregating contributing factors in error events into a useful format. Using this approach offers consistency in investigation and a framework for making sense of data. For this article, sedatives and analgesic medication related events are considered.

Clinical Competence↗

PubMedDate not supplied

Genesis of a professional development tool for ambulatory pediatric nursing practice.

The purpose of this project was to develop a system that would allow ambulatory pediatric nurses to describe their practice and to develop in their role as nurses. Patricia Benner's novice to expert philosophy has been used to describe the practice of nurses in many specialties; however, it has not been applied to ambulatory pediatric practice. A group of nurses at Children's Hospital of Wisconsin used Benner's philosophy to generate behaviors that evolved from the novice to the expert within the domains of nursing practice outlined in the ambulatory nurse job description. This tool has been implemented as part of the performance review process and is given to new nurses on orientation as a framework for nurses' professional development.

Ambulatory Care↗

PubMed1998

Managing evidence-based health care: a diagnostic framework.

This paper proposes a diagnostic framework useful to Trust managers who are faced with the task of devising and implementing strategies for improvements in clinical effectiveness, and is based on a recent study incorporating clinicians, managers, and professional staff in four NHS Trusts in the North Thames Region. The gap framework is inspired by the gap model developed by Zeithaml, Parasuraman and Berry from their research into service quality and incorporates Dave Sackett's schema as well as a personal competency profile needed for the practice of evidence based health-care (EBHC). The paper highlights the four organisational and personal failures (gaps) which contribute to the fifth gap, namely the discrepancy between clinically relevant research evidence and its implementation in health care. To close the gaps, Trusts need to set the goal and tackle the cultural, organisational, attitudinal and more material aspects such as investment in the information infrastructure, education and training of doctors. Doctors need to go through a process from awareness to action facilitated through a combination of personal and organisational incentives and rewards as well as training in the requisite skills. Researchers should take steps to improve the quality of the evidence and its accessibility and purchasers should reinforce the use of EBHC by withdrawing funding for care which has proved to be ineffective, inappropriate or inferior.

Awareness↗

PubMed2003

Intergroup conflict: individual, group, and collective interests.

Intergroup conflicts generally involve conflicts of interests within the competing groups as well. This article outlines a taxonomy of games, called team games, which incorporates the intragroup and intergroup levels of conflict. Its aims are to provide a coherent framework for analyzing the prototypical problems of cooperation and competition that arise within and between groups, and to review an extensive research program that has used this framework to study individual and group behavior in the laboratory. Depending on the game's payoff structure, contradictions or conflicts are created among the rational choices at the individual, group, and collective levels-a generalization of the contradiction between individual and collective rationality occurring in the traditional mixed-motive games. These contradictions are studied so as to identify the theoretical and behavioral conditions that determine which level of rationality prevails.

Choice Behavior↗

PubMed2005

The relationship between childbearing and transitions from marriage and cohabitation in Britain.

In this article, we describe a general framework for the analysis of correlated event histories, with an application to a study of partnership transitions and fertility among a cohort of British women. Using a multilevel, multistate competing-risks model, we examine the relationship between prior fertility outcomes (the presence and characteristics of children and current pregnancy) and the dissolution of marital and cohabiting unions and movements from cohabitation to marriage. Using a simultaneous-equations model, we model these partnership transitions jointly with fertility, allowing for correlation between the unobserved woman-level characteristics that affect each process. The analysis is based on the partnership and birth histories that were collected for the 1958 birth cohort (National Child Development Study) aged 16-42. The findings indicate that preschool children have a stabilizing effect on their parents 'partnership, whether married or cohabiting, but the effect is weaker for older children. There is also evidence that although pregnancy precipitates marriage among cohabitors, the odds of marriage decline to prepregnancy levels following a birth.

Adolescent↗