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PubMed1990

Occupational therapy in acute inpatient psychiatry: an activities health approach.

This article discusses some of the challenges that occupational therapists working in acute psychiatric inpatient settings commonly face. There is often a lack of sufficient time available for treatment as well as limitations inherent in addressing functional problems in the artificiality of a hospital environment. A theoretical framework is introduced from which the role of occupational therapy and realistic objectives for acute short-term care can be identified. This framework for inpatient occupational therapy practice is based on the concept of activities health, which provides a definition of health in functional rather than medical terms. The importance of emphasizing the patient's competence in roles assumed in community living is emphasized. A step-by-step approach to program development with specific examples is also provided.

Activities of Daily Living↗
PubMed2001

Exploring the experiences of beginning registered nurses entering the acute care setting.

This study begins to explore some of the social and political issues surrounding the practices of the graduate nurse. Utilising an ethnographic methodology with a critical intent, 4 graduate nurses describe their experiences of clinical practice. The major themes raised or issues that were embedded within the nurses' stories revolved around power and control enmeshed within nursing practice. The themes discussed relate to the graduates' perception of their own competence, and the concepts of the ideal nurse, the socialisation of graduates into the ward culture, being on insider or outsider and a good or bad nurse. The resulting discussion utilises the theoretical framework of Foucault's governmentality to suggest ways in which nurses and graduates might make sense of these issues.

Adult↗
PubMed1999

The clinical doctorate: a framework for analysis in physical therapist education.

This article explores major considerations for analysis and discussion of the role of the clinical doctorate as the first professional degree in physical therapist education (DPT). A process for this analysis is posed based on a conceptual framework developed by Stark, Lowther, Hagerty, and Orczyk through grounded theory research on professional education. External influences from society and the profession, institutional and programmatic influences, and articulation of critical dimensions of professional competence and professional attitudes as major categories are discussed in relation to the DPT. A series of questions generated from the application of the model are put forth for continued discussion and deliberation concerning the DPT. We conclude that the DPT provides the best pathway to serve society, the patient, and the profession.

Clinical Competence↗
PubMedDate not supplied

Physician-centered management guidelines.

The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

Efficiency, Organizational↗
PubMed1992

The optimal functioning plan. A key element in cancer rehabilitation.

Individuals with cancer should be assisted to achieve optimal levels of functioning before, during, and after cancer treatment. However, to reach optimal functioning a well-defined plan of action is required. This article presents an Optimal Functioning Plan (OFP) aimed at attaining the best possible outcomes for all individuals treated for cancer. The OFP centers on physical functioning, nutritional adequacy, a practical level of independence in activities of daily living, self-care competence, a realistic optimistic outlook, and effective management of side effects. The OFP is a key element of cancer rehabilitation. It represents a way of packaging cancer care in a health-oriented framework.

Goals↗
PubMed1995

[Supervision for nursing personnel: more than psychohygiene? 2. The importance of supervision for the professionalization of nursing].

Supervision as a means to improve professionalism in nursing. In the first part of the essay it was shown that the literature emphasises the psychohygiene function of supervision. This was contrasted with the function of systematic reflection on professional action, which is more important for the professionalisation of nursing. This second part describes how experiential knowledge is acquired by reflection. Supervision is shown to parallel nursing research. The paper discusses the necessary framework for supervision and the demands made on supervisors in this field.

Humans↗
PubMed1995

Multiple mentoring relationships facilitate learning during fieldwork.

Fieldwork provides a means by which students are socialized into their profession and their careers. During Level I and Level II fieldwork, students acquire and apply the knowledge, skills, and attitudes that will enable them to achieve entry-level competence The experiences that students have during Level II fieldwork influence their subsequent career choices. To support these experiences, students form a variety of helping relationships with faculty members, clinicians, peers, family, and friends. This article examines the role and responsibilities of the student as protégé and of the clinical educator as information peer, collegial peer, special peer, and mentor. In light of the challenges faced by most clinicians secondary to health care reform, an alternative to the one-to-one supervision model is presented. The multiple mentoring model of fieldwork supervision has several advantages: (a) fieldwork educators work with students according to their strengths and interests; (b) the model promotes collegiality and clinical reasoning skills because students use each other as resources and observe different fieldwork educators approaching similar situations; and (c) the model allows a fieldwork site to accept more students at one time, while minimizing stress on any one fieldwork educator. A framework defining the functions of the mentor-protégé relationship is provided, with an emphasis on the effect that clinical educators have in their roles as mentors, guides, role models, and teachers who provide opportunities for the student to develop entry-level competency in a chosen profession.

Humans↗
PubMed2001

Combining qualitative and quantitative methods in assessing hospital learning environments.

Clinical education is a vital component in the curricula of pre-registration nursing courses and provides student nurses with the opportunity to combine cognitive, psychomotor, and affective skills. Clinical practice enables the student to develop competencies in the application of knowledge, skills, and attitudes to clinical field situations. It is, therefore, vital that the valuable clinical time be utilised effectively and productively. Nursing students' perception of the hospital learning environment were assessed by combining quantitative and qualitative approaches. The Clinical Learning Environment Inventory, based on the theoretical framework of learning environment studies, was developed and validated. The quantitative and qualitative findings reinforced each other. It was found that there were significant differences in students' perceptions of the actual clinical learning environment and their preferred learning environment. Generally, students preferred a more positive and favourable clinical environment than they perceived as being actually present.

Attitude of Health Personnel↗
PubMed1992

Continuous improvement of nursing practice: experience in Québec.

Health care professionals must be accountable for the quality of their practice and self-regulating professional organizations have the responsibility to ensure that the public receives the best possible care to which it is entitled. Québec's legislation mandates professional corporations to supervise the practice of their members. The nursing profession comes under that legislation and, at l'Ordre des infirmières et infirmiers du Québec, a program of professional inspection has existed since 1976. The philosophy of this program is based on individual and collective responsibility of nurses towards the continuous improvement of their practice and the enhancement of the quality of care they provide. Standards and criteria of competence were elaborated with the participation of groups of nurses, validated by large samples of the population and distributed to all nurses. Evaluation tools were devised and have progressed over the years. The concepts of self-evaluation (Bandura, Am Psychol 33: 344, 1978; Bandura, Prentice Hall, 1986; Knox and MacKay, Nurs Papers/Perspect Nurs 4: 17, 1982) and of self-managed collective development (Payette, Rev québécoise Psychol 5: 104, 1984) have inspired the program, allowing nurses to identify their needs, set priorities and determine their plan of action. A study to evaluate the impact of the program is now in progress. This article will describe the conceptual framework, the method of evaluation, its application, the reactions of nurses as well as some of the results observed concerning the improvement of practice and of quality of care.

Canada↗
PubMed2001

Paradigms, promises, and the potential of clinical psychology.

Both Plaud's and Ilardi and Feldman's articles call for clinical psychology to redefine itself according to a particular paradigm or "unifying framework." This commentary focuses on the nature of clinical psychology as an applied discipline, whether clinical psychology in fact has an urgent need for a unifying framework, and whether radical behaviorism or cognitive neuroscience could provide such a framework. It is concluded that, as an applied field that draws both theory and method from a number of natural and social sciences, clinical psychology is served best by continued development and appropriation of competing scientific viewpoints rather than by fealty to a single perspective or paradigm.

Behaviorism↗
PubMed2003

Gatekeeping strategies for clinical trials that do not require all primary effects to be significant.

In this paper we describe methods for addressing multiplicity issues arising in the analysis of clinical trials with multiple endpoints and/or multiple dose levels. Efficient 'gatekeeping strategies' for multiplicity problems of this kind are developed. One family of hypotheses (comprising the primary objectives) is treated as a 'gatekeeper', and the other family or families (comprising secondary and tertiary objectives) are tested only if one or more gatekeeper hypotheses have been rejected. We discuss methods for constructing gatekeeping testing procedures using weighted Bonferroni tests, weighted Simes tests, and weighted resampling-based tests, all within the closed testing framework. The new strategies are illustrated using an example from a clinical trial with co-primary endpoints, and using an example from a dose-finding study with multiple endpoints. Power comparisons with competing methods show the gatekeeping methods are more powerful when the primary objective of the trial must be met.

Clinical Trials as Topic↗
PubMed2004

The developmental psychopathology of self-injurious behavior: compensatory regulation in posttraumatic adaptation.

This article utilizes a developmental psychopathology framework to explicate one pathway, originating in childhood traumatic experience, toward the development of self-injurious behavior (SIB). The descriptive psychopathology of SIB is summarized first, followed by an overview of theoretical interpretations of SIB within psychoanalytic, neo-analytic, behavioral, and biological paradigms. Building on these empirical and theoretical foundations, a developmental psychopathology framework is used to model the development of SIB in the aftermath of childhood traumatic experience, particularly maltreatment. In this model, maltreatment undermines positive adaptation at motivational, attitudinal, instrumental, emotional, and/or relational levels of competence. In turn, vulnerabilities in the child's adaptive resources necessitate the application of alternative regulatory and relational strategies, such as self-injury, to the negotiation of contemporaneous and prospective developmental issues. The article concludes with a discussion of the empirical and clinical implications of a developmental understanding of SIB as a compensatory regulatory strategy in posttraumatic adaptation.

Adaptation, Psychological↗
PubMed2006

Salience, relevance, and firing: a priority map for target selection.

The salience map is a crucial concept for many theories of visual attention. On this map, each object in the scene competes for selection - the more conspicuous the object, the greater its representation, and the more likely it will be chosen. In recent years, the firing patterns of single neurons have been interpreted using this framework. Here, we review evidence showing that the expression of salience is remarkably similar across structures, remarkably different across tasks, and modified in important ways when the salient object is consistent with the goals of the participant. These observations have important ramifications for theories of attention. We conclude that priority--the combined representation of salience and relevance--best describes the firing properties of neurons.

Action Potentials↗
PubMed2002

Developing linguistic literacy: a comprehensive model.

This is a position paper modelling the domain of linguistic literacy and its development through the life span. It aims to provide a framework for the analysis of language development in the school years, integrating sociolinguistic and psycholinguistic notions of variation, language awareness, and literacy in a comprehensive model. The paper focuses on those aspects of literacy competence that are expressed in language as well as aspects of linguistic knowledge that are affected by literacy competence, tracing the route that children take in appropriating linguistic literacy as part of their cognitive abilities and examining the effect of literacy on language across development. Our view of linguistic literacy consists of one defining feature: control over linguistic variation from both a user-dependent ('lectal') and a context-dependent (modality, genre, and register) perspective; of one concomitant process: metalanguage and its role in language development; and of one condition: familiarity with writing and written language from two aspects: written language as discourse style--the recognition that the kind of language used for writing is essentially different from the one used for speech; and written language as a notational system--the perception and growing command of the representational system that is used in the written modality. Linguistic literacy is viewed as a constituent of language knowledge characterized by the availability of multiple linguistic resources and by the ability to consciously access one's own linguistic knowledge and to view language from various perspectives.

Awareness↗
PubMed1996

Factors influencing registered nurses teaching breast self-examination to female clients.

A university hospital-based study was conducted to explore factors that influence nurses teaching breast self-examination (BSE) to female clients, using the PRECEDE (Predisposing, Reinforcing, and Enabling factors in Educational Diagnosis and Evaluation) model as an organizing framework. Female registered nurses (N = 140) from adult inpatient and outpatient units completed a questionnaire that included items about frequency of BSE, knowledge of breast cancer screening and BSE technique, health motivation, confidence and competence in performing BSE, and teaching BSE. Data analysis compared the characteristics of nurses who reported teaching BSE with nurses who did not teach. Nurses in the teaching group had more work experience in nursing and were more likely to have a friend with breast cancer than were those in the nonteaching group. The teaching group had more knowledge about breast cancer screening and BSE technique and reported more confidence and competence in performing BSE.

Adult↗
PubMedDate not supplied

The curriculum blueprint: an application to nurse practitioner education.

A psychometric model for the construction of examinations (the test construction process) is adapted as a conceptual framework for curriculum design. The outcome of the process, the curriculum blueprint, is proposed as particularly advantageous for nurse practitioner education, which is somewhat unique among nursing specialties in its need to accommodate the competing demands of several regulatory or educational approval bodies that influence the content of its curriculum. The curriculum blueprint provides a visual dimension and therefore is useful as a communication tool. An excerpted example of a curriculum blueprint is offered.

Curriculum↗
PubMed1992

Improving psychotherapy services: applications of research, audit and evaluation.

Psychotherapy services face increasing demand but are vulnerable to critical scrutiny by service purchasers seeking evidence of cost-effectiveness. Psychotherapy research, although it can benefit practitioners, cannot adequately address these concerns because of poor external validity and it is argued that complementary strategies are needed. A number of service-based evaluative methods are reviewed and the distinctions clarified between service evaluation, operational research, professional audit, service audit, quality assurance and total quality management. Maxwell's (1984) six category framework is used to examine a number of issues in psychotherapy services including the assessment process, treatment-of-choice decisions, predicting negative effects of treatment, dose-response in psychotherapy, brief interventions, therapist competence, clinical significance, cost effectiveness and measures of psychotherapy service inputs, process and outcomes. This review advocates reflective practice within a self-evaluating psychotherapy service and a systemic approach which can take account of the perspectives of patients, purchasers, service managers, referrers and practitioners.

Follow-Up Studies↗