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PubMed2000

Clinical supervision as an emancipatory process: avoiding inappropriate intent.

As clinical supervision becomes more widely implemented in the United Kingdom with concerns and resistances being eroded as practitioners discover its benefits, it is important that potential limitations and perhaps failures are avoided. This paper utilizes Johns' (1996) intent-emphasis axis to explore how a technical interest, misunderstanding of expert practice, and confusion of self awareness with counselling, can detract from the supervisory process. Several of the criticisms of reflective practice will be examined to demonstrate where concerns are valid and where they may be based on misunderstandings and the need to control clinical supervision. Greater awareness of inappropriate emphasis and intent should enable even relatively inexperienced supervisors to help their supervisees move towards independence, emancipation and evolving expertise.

Attitude of Health Personnel↗

PubMed2001

Nurses' behavioural intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables.

BACKGROUND: The incidence of self-poisoning is on the increase. Most patients who self-poison are dealt with initially in the general hospital. Therefore, the type and quality of care self-poisoning patients receive will depend, in part, on how they are viewed by nursing staff within the general hospital setting. A knowledge and understanding of the attitudes held by nurses towards self-poisoning patients is therefore important to those involved in the planning and delivery of care towards this client group. Previous studies have examined health care professionals' attitudes towards people who self-poison. Usually, however, these have not focused specifically on nurses' attitudes, and they have ignored the relationship between the attitudes expressed by staff and their intentions to engage in subsequent caring behaviour of one sort or another. It is hence unclear how the findings of such studies are relevant or applicable to nursing policy and practice. AIMS: The present study aims to address these limitations using a methodology informed by the theory of reasoned action. The study aims to separate out the distinctive roles played by nurses' own attitudes, and the social pressures represented by other people's attitudes, in determining the types of caring behaviour in which nurses intend to engage when dealing with self-poisoning patients. DESIGN/METHODS: The study adopts a questionnaire-based approach incorporating two specially designed vignettes. RESULTS: The results show that nurses' own attitudes, and what they believe about the attitudes of others, predict their behavioural intentions towards self-poisoning patients. The study also shows that nurses with a more positive orientation towards self-poisoning patients differ in behavioural and normative beliefs from nurses who have a less positive orientation. CONCLUSIONS: The implications for future attempts to explore the relationship between nurses' attitudes and subsequent caring behaviour are considered, along with implications for nursing policy and practice.

Attitude of Health Personnel↗

PubMed2000

Prediction of intern attendance at a seminar-based training programme: a behavioural intention model.

CONTEXT: The factors determining intern attendance at 'resident rounds' training programmes are not known. AIMS: This study aimed to use a behavioural model (the Triandis theory of social behaviour) to predict intern attendance at the resident round programme at a metropolitan teaching hospital. SUBJECTS: These included 109 interns in a large metropolitan teaching hospital, in the 1996 and 1997 cohorts. METHODS: Tabulated responses from a structured interview administered to 10 randomly selected interns were used to develop survey items related to the Triandis variables. Attendance was monitored using a sessional logbook and by self-report. Item analysis was conducted for each variable scale. Stepwise multiple regression models were constructed to predict attendance and intention. RESULTS: The average proportion of resident rounds attended was 43% (95% confidence intervals (CI) 40-47%) from logbook attendance, and 63% (95% CI 61-65%) by self-report. Cronbach's alpha for the subscales ranged from 0.62 to 0.91. Intern attendance was predicted by the habit of attendance and negatively predicted by facilitating conditions (AdjR2=0.26, P<0.0001). The intention to attend was only independently predicted by perceived consequences (AdjR2= 0.19, P < 0.0001). CONCLUSIONS: The establishment of resident education programmes within teaching hospitals requires attention to and modification of facilitating conditions that may allow improvements in attendance and in quality of the programme.

Adult↗

PubMed2000

The effectiveness of the haemodialysate Solcoseryl for second-intention wound healing in horses and ponies.

Second-intention healing of limb wounds in horses is often problematic. Solcoseryl is a protein-free, standardized dialysate/ultrafiltrate (HD) derived from calf blood, which has been shown to improve healing in both animals and humans. The efficacy of HD in the healing of deep wounds in horses and ponies was investigated. Deep wounds of 20 by 35 mm were created on both metatarsi (skin, subcutis, periosteum) and on both femoral biceps muscles (skin, subcutis, muscle) of five horses and five ponies. The wounds on one side were treated with HD, four times a week during the period that the wounds were bandaged and once daily thereafter. The wounds on the other side were left untreated. In the first 4 weeks of the healing period HD stimulated healing but inhibited healing thereafter. This pattern was significant for all wound groups (P < 0.001). Because of this change in effect, the overall effect on wound healing over the entire period was not significant (P = 0.77). HD stimulated healing initially by provoking a greater initial inflammatory response, faster contraction and faster formation of granulation tissue. Subsequently, HD inhibited healing because it significantly delayed epithelialization and caused protracted inflammation. The effects of HD were most pronounced in the horses. Because this study distinguished between contraction and epithelialization, it could be shown that HD stimulated contraction but inhibited epithelialization. Therefore, HD is useful in horses for the treatment of deep wounds during the initial phase of healing by second intention, i.e. during the first weeks when wound contraction can be expected. Treatment should be ceased when epithelialization becomes predominant.

Actihaemyl↗

PubMed2001

Determinants of nurses' intention to administer opioids for pain relief.

A statewide cross-sectional survey was conducted in Australia to identify the determinants of registered nurses' intention to administer opioids to patients with pain. Attitudes, subjective norms and perceived control, the key determinants of the Theory of Planned Behavior, were found to independently predict nurses' intention to administer opioids to these patients. Perceived control was the strongest predictor. Nurses reported positive overall attitudes towards opioids and their use in pain management. However, many negative attitudes were identified; for example, administering the least amount of opioid and encouraging patients to have non-opioids rather than opioids for pain relief. The findings related to specific attitudes and normative pressures provide insight into registered nurses' management of pain for hospitalized patients and the direction for educational interventions to improve registered nurses' administration of opioids for pain management.

Attitude of Health Personnel↗

PubMed2002

EEG theta synchronization conjoined with alpha desynchronization indicate intentional encoding.

The involvement of different oscillating neuronal systems activated during intentional learning was investigated by measuring ongoing EEG activity. In 17 subjects, the EEG was recorded while learning pairs of words and faces. Subjective task difficulty was rated and a control condition of mental relaxation was also run. Spontaneous EEG activity during epochs which subsequently resulted in efficient encoding was associated with upper alpha desynchronization (10-12 Hz) and theta synchronization (4-8 Hz) when compared with spontaneous EEG activity during epochs of poor recall performance. The combined measure of theta synchronization plus upper alpha desynchronization was enhanced selectively over left frontotemporal cortical regions during efficient learning of words and over right parietal cortical regions during efficient learning of faces (P < 0.001). This striking topographical dissociation between learning materials for the combined measure of theta and upper alpha EEG activity suggests that the mode of intentional learning relies essentially on an interdependent regulation of two neuronal circuits: the thalamo-cortical circuit and the hippocampo-cortical circuit.

Action Potentials↗

PubMed2003

Regional variation in wound contraction of mohs surgery defects allowed to heal by second intention.

BACKGROUND: The phenomenon of wound contraction results in a decrease in wound size and a healed scar significantly smaller than the original defect. OBJECTIVE: This study was undertaken (1) to determine the amount of wound contraction in Mohs surgery defects allowed to heal by second intention, (2) to evaluate for regional differences in wound contraction based on the facial anatomic zones for second intention healing described by Zitelli, and (3) to determine whether regional differences in wound contraction account for observed differences in cosmetic outcome. METHODS: One hundred sixty secondarily healed Mohs surgery defects limited to the head and neck having a wound age of greater than 12 weeks in 102 consecutively examined patients were carefully measured with a tissue caliper. The percent wound contraction was calculated and compared for each Zitelli anatomic subunit. The final shape of the wound (quantitatively described) and the cosmetic acceptability (subjectively rated by the patient and examiner) were also compared with the percent wound contraction for each anatomic area. RESULTS: Both NEET (concave surface of the nose, eye, ear, and temple) and FAIR (forehead, antihelix, eyelids, and the remainder of the nose, lips, and cheeks) areas were identical in terms of mean wound contraction (74%), cosmetic acceptability (97%), and conversion to a wound shape with a ratio of maximal length to width of greater than 3.0 (fusiform and linear shapes) (52%). NOCH areas (convex surface of the nose, oral lips, cheeks and chin, and the helix of the ear) demonstrated less wound contraction (66%), cosmetic acceptability (78%), and fusiform-linear conversion (29%). Subset differences and variables that appear to influence wound contraction are discussed. Secondarily healed wounds in areas with one or more positive contraction variables contract 75%, whereas defects in areas with negative contraction variables contract 55%. CONCLUSIONS: Regional differences in wound contraction of secondarily healed head and neck wounds exist and account for some differences in cosmetic acceptability. Scar location, regardless of the degree of wound contraction, is the most important factor for the final cosmetic outcome.

Adult↗

PubMed2004

Intentional replantation - a 'last resort' treatment or a conventional treatment procedure? nine case reports.

Intentional replantation is an accepted endodontic treatment procedure in which a tooth is extracted and treated outside the oral cavity and then inserted into its socket to correct an obvious radiographic or clinical endodontic failure. This article reviews nine cases of intentional replantation (IR) that show the feasibility of the procedure in a variety of indications. Only one case of replantation showed evidence of pathosis that reflected root resorption or ankylosis. This report suggests that IR is a reliable and predictable procedure and should be more often considered as a treatment modality in our efforts to maintain the natural dentition.

Adult↗

PubMed2003

Intentional replantation with 180 degrees rotation of a crown-root fracture: a case report.

Crown root fractures are frequently difficult to treat and have a bad prognosis. To restore the biological space, intentional replantation can be chosen when osteotomy/osteoplasty and dental traction are not viable. Intentional replantation with tooth rotation consists of extraction, 180 degrees rotation and replantation, thus restoring the biological space. After treatment of inflammatory resorption with calcium hydroxide, endodontic treatment was completed. The patient was followed up with clinical examination (mobility test, gingival sulcus depth) and radiographic analysis (to analyze root resorption: inflammatory and/or substitution, and the integrity of the alveolar cortex and the periodontal space) for 3 years and there were no signs of resorption.

Child↗

PubMed2003

[The planning of action: can one separate attention from intention?].

Attention and motor preparation are two intimately linked processes. However, they can be dissociated in the laboratory in order to study their neuronal basis. Behavioral neurophysiology has thus shown that neurons that discharge in relation with attention or with motor preparation (or intention) exist in a variety of brain regions in the monkey, especially the prefrontal and premotor cortices. When examined more carefully, these two regions appear different in both the proportion of cells that respond during attention versus intention, and in the information coded in the so-called "preparatory activity". This activity reflects sensory selection in the prefrontal cortex (spatial attention/memory), motor selection in the premotor cortex. Furthermore, two regions in the dorsal aspect of premotor cortex can be distinguished on the basis of their relative involvement in attention: a rostral (anterior) region, functionally close to prefrontal cortex, and a caudal one, which appears functionally close to motor cortex. Using an experimental design derived from monkey experiments, a functional magnetic resonance imaging (fMRI) study recently indicated that the functional specialization within the premotor cortex is similar in monkey and man.

Animals↗

PubMed2002

Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list.

A major obstacle for orthotopic liver transplantation (OLT) as treatment for hepatocellular carcinoma (HCC) is tumor growth resulting in dropout from the waiting list for OLT. There is a paucity of data on survival according to intention-to-treat analysis and the rate of dropout from the waiting list for OLT among patients with HCC. To further evaluate these issues, we analyzed the outcome of 46 consecutive patients with HCC listed for OLT between January 1998 and January 2001. Exclusion criteria for OLT were tumor size greater than 5 cm for one to three lesions or four lesions or greater of any size. Twenty-one patients underwent OLT. There were 11 dropouts because of tumor progression and six deaths, including three deaths after dropout. Kaplan-Meier 1- and 2-year intention-to-treat survival rates were 91.7% and 72.6%, respectively. Monthly dropout rates were 0% from 0 to 3 months, 1.5% from 3 to 6 months, 1.0% from 6 to 9 months, 4.9% from 9 to 12 months, and 5.6% from 12 to 15 months. One dropout occurred beyond 15 months among 4 patients remaining at risk. Cumulative probabilities for dropout at 6, 12, and 24 months were 7.3%, 25.3%, and 43.6%, respectively. Predictors for dropout included two or three tumor nodules or a solitary lesion greater than 3 cm at initial presentation and previous hepatic resection. Our results support recent changes in the scheme of organ allocation aimed at reducing the dropout rate and improving outcome for patients with HCC awaiting OLT.

Carcinoma, Hepatocellular↗

PubMed1975

Intention myoclonus of multiple sclerosis, its patho-anatomical basis and its stereotactic relief.

The typical multiple sclerosis case considered here is especially informative from both the standpoint of its clinical course and on the basis of the autopsy findings. The foci responsible for the severe bilateral intention myoclonus of the trunk and limbs are the nerve cell losses in both red nuclei due to extensive and almost complete demyelination. Thereby the triangle of Mollaret between the red nucleus, inferior olives and dentate nucleus is involved as the patho-physiological circuit responsible for myoclonus. Stereotactic coagulation of dentato-thalamic fibres resulted in complete relief of intention myoclonus. With regard to the triggering of fresh demyelinating foci by stereotactic interventions, our point of view is as follows: Although a stereotactic operation introduces the possibility of triggering new demyelinating foci in less than 10% of the cases, such a possibility does not represent an absolute contra-indication to the stereotactic treatment of action myoclonus in multiple sclerosis, if the patient is informed accordingly.

Adult↗

PubMed2005

Job and organizational determinants of nursing home employee commitment, job satisfaction and intent to turnover.

The purpose of this study was to examine whether job characteristics, the work environment, participation in quality improvement activities and facility quality improvement environment predicted employee commitment and job satisfaction in nursing homes, and whether those same predictors and commitment and satisfaction predicted turnover intention. A total of 6,584 nursing home employees from 76 nursing homes in a midwestern state participated. A self-administered questionnaire was used to collect the data. The results supported the hypotheses that job and organizational factors predicted commitment and satisfaction while commitment and satisfaction predicted turnover intentions. The implications for retaining nursing home employees are discussed.

Adult↗

PubMed1998

Intentionality during hypnosis: an ironic process analysis.

Two studies were completed to test whether responding to hypnotic suggestions requires intentional effort. Hypnotic suggestions for amnesia were used as an analog of thought suppression, and Wegner's model of ironic processing was applied to hypnotic responding. In the first study, participants were required to maintain suggested amnesia while performing a cancellation task with and without a cognitive load. The second study required suppression of thoughts of a favorite car, once with "blank-mind" instructions and then with a suggestion for amnesia. The results of these studies indicate that dissociated control theory provides the best explanation for hypnotic responding in one subset of highly hypnotizable participants, whereas more intentional responding provides the best explanation for others.

Adult↗

PubMed1976

Components of suicidal intent in completed and attempted suicides.

An objective suicidal intent scale was completed for 235 completed suicides and 246 attempted suicides in Philadelphia. The responses to the items of the suicidal intent scale were factor analyzed separately for the two groups, and the pattern of factors compared. The major difference centered around communication. For the completed suicide the decision appears to be whether or not to communicate; for the attempted suicide the decision appears to be when to communicate.

Communication↗

PubMed1998

Predicting back pain sufferers' intentions to exercise.

One important factor in reducing back pain is the performance of exercises prescribed by physicians during treatment. The present investigation was conducted to examine the correlates of an individual's intention to adhere to such prescriptions. On the bases of M. Fishbein's (1980) theory of reasoned action and I. Ajzen's (1988) theory of planned behavior, attitudes, subjective norms, and 2 types of perceived behavioral control were measured in a sample of American patients. Attitudes and subjective norms failed to predict intentions to exercise in accordance with the physician's orders, but each of the perceived behavioral control measures did moderately well as an independent predictor and quite well when combined in a multiple regression approach.

Exercise↗

PubMed1999

The impact of emotional dissonance on organizational commitment and intention to turnover.

In the workplace, emotional dissonance is the conflict between experienced emotions and emotions expressed to conform to display rules. This study is an empirical examination of the impact of emotional dissonance on organizational criteria and its moderation by self-monitoring and social support. Emotional dissonance was theorized to stimulate turnover intentions, either solely through job dissatisfaction or through both job dissatisfaction and reduced organizational commitment. Job dissatisfaction was found to be the sole mediator. Emotional dissonance resulted in job dissatisfaction, which, in turn, stimulated withdrawal intentions. Self-monitoring and social support exerted moderator effects, albeit in opposing directions. Emotional dissonance aroused feelings of job dissatisfaction and reduced organizational commitment among high self-monitors. In contrast, social support lessened the negative impact of emotional dissonance on organizational commitment.

Adaptation, Psychological↗

PubMed1999

Mood and organizational citizenship behavior: the effects of positive affect on employee organizational citizenship behavior intentions.

This study, involving 139 employees from a variety of industries, organizations, and positions in Singapore, measured the effects of mood on the intentions of employees to contribute actions that are organizationally desirable but are not part of their formal job requirements (organizational citizenship behavior). After effects of established patterns of historical organizational citizenship behavior, demographic characteristics, and employee positive and negative affectivity had been controlled, stepwise regression analysis revealed that the amount of positive affect currently experienced by an employee significantly influenced the employee's intention to perform specific acts of organizational citizenship.

Administrative Personnel↗