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PubMed2006

The Yapunyah project: embedding Aboriginal and Torres Strait Islander perspectives in the nursing curriculum.

The Yapunyah Project is an initiative of the Faculty of Health at Queensland University of Technology. It was instigated to further improve the development of cultural competence in health graduates with respect to Aboriginal and Torres Strait Islander perspectives. The project was informed by the cultural competence in healthcare delivery models of Campinha-Bacote (1998a) and Cross, Bazron, Dennis and Isaacs (1989) and by the cultural safety reforms to nursing curricula in New Zealand. The Yapunyah Project involved extensive consultation and collaboration with Indigenous staff and health experts in the local Aboriginal and Torres Strait Islander community. A core curriculum, and associated graduate transcultural competencies, were informed by these discussions and earlier reforms in health curricula by the Committee of Deans of Australian Medical Schools and the Royal Australian College of General Practitioners. Although the overall project involved four separate schools within the faculty, this paper details the experience of embedding Indigenous perspectives within the undergraduate nursing curriculum. The experience has been a challenging and positive one, and the reforms have been supported by a sustainable framework. This paper outlines how one university faculty is endeavouring to educationally prepare nursing students to practice with evidence-based transcultural nursing knowledge based on culture care values, beliefs, and traditional lifeways of Indigenous people of Australia. As such, the project aims to contribute to the improvement and promotion of the health and well-being of Indigenous Australians in culturally and ethnohistorically meaningful ways.

Australia↗

PubMed2001

Ethical issues in early-intervention clinical trials involving minors at risk for schizophrenia.

Early-intervention clinical trials involving persons at risk for schizophrenia raise a variety of ethical issues. These issues range from some of the most general questions of ethical theory and research ethics to some very specific pragmatic questions about optimal procedures for protecting subjects. Giving special attention to minor subjects (and adult subjects lacking decision-making capacity), this paper aims to provide an overview of some leading ethical issues and concerns as well as a rights-based framework and several concrete suggestions for addressing these issues and concerns.

Adolescent↗

PubMed2002

Towards a 'forensic lens' model of multidisciplinary training.

This paper reports on research undertaken to identify if common areas of multidisciplinary training exist in the literature. The literature that specifically focused on training issues in forensic practice (mental health) was located and reviewed by coding analysis. Thirteen common areas were identified and approximately 250 content items were acknowledged. A 'forensic lens' model was established to provide a framework in which multidisciplinary training could be located. Further research is promulgated to establish the actual importance of each training area for specific forensic disciplinary groups.

Clinical Competence↗

PubMed1999

ASSET: a model for actioning spirituality and spiritual care education and training in nursing.

This paper presents a model of spiritual care education. A definition of spirituality is offered, this is followed by a review of empirical studies on spirituality and nurse education which conclude that nurses' knowledge and skills related to spiritual care are impoverished because of a poor role preparation in this dimension of care. The asset model (actioning spirituality and spiritual Care education and training in Nursing) is recommended as a possible option for improving spiritual care education in nursing. It should prove to be a useful framework and catalyst in effecting change in nurses' knowledge and understanding of the spiritual care requirements of patients. Extensive details of this model are provided in this paper.

Clinical Competence↗

PubMed2003

Cross-cultural medical education: conceptual approaches and frameworks for evaluation.

Given that understanding the sociocultural dimensions underlying a patient's health values, beliefs, and behaviors is critical to a successful clinical encounter, cross-cultural curricula have been incorporated into undergraduate medical education. The goal of these curricula is to prepare students to care for patients from diverse social and cultural backgrounds, and to recognize and appropriately address racial, cultural, and gender biases in health care delivery. Despite progress in the field of cross-cultural medical education, several challenges exist. Foremost among these is the need to develop strategies to evaluate the impact of these curricular interventions. This article provides conceptual approaches for cross-cultural medical education, and describes a framework for student evaluation that focuses on strategies to assess attitudes, knowledge, and skills, and the impact of curricular interventions on health outcomes.

Attitude of Health Personnel↗

PubMed2005

Analysing the concept of context in medical education.

BACKGROUND: There is increasing interest in the role of context in medical education, with the conjecture that learning in a clinical context may be helpful for later recall of knowledge. Although this may be true in a general sense, at a closer look it appears that the notion of context is not well substantiated in the medical education literature and that the concept is not clearly defined. Effects of context on learning appear to depend on type of learning task, the relationship or interaction between the context and the learning material, and motivational features of the context. Context is often implicitly regarded as a uniform concept but conceptual analysis shows that a distinction can be made in several dimensions. RESULTS: In this paper, we identify 3 different dimensions of context: a physical dimension, representing the environmental characteristics; a semantic dimension, reflecting how well the context contributes to the learning task, and a commitment dimension, representing the amount of commitment (in terms of motivation and responsibility) that is generated by the context. On these dimensions, context can be ordered from reduced (providing few cues, little meaning, little commitment) to enriched (many cues, much meaning, high commitment). CONCLUSION: This model can serve a dual purpose: first, to disentangle several aspects of educational contexts (e.g. as high in meaning but low in commitment), and second, to provide a theoretical framework to generate research on the influence of different contexts in education on students' learning.

Clinical Competence↗

PubMed1984

The design of a new physician licensure examination.

Many health professions include written examinations among their licensing procedures, and constructing these examinations poses special difficulties. For physician licensure the central dilemma is manifested by the longstanding tradition of undifferentiated licensure contrasting with the strong specialty orientation of contemporary physician training. This article details the authors' response to this problem and describes the resulting design of a new physician licensure examination. Using a combination of empirical data and expert judgment, descriptions of selected clinical encounters have been assembled as a practice model of a physician licensed for the delivery of general health care of patients. Application of an explicitly situational framework to the design of a physician licensure examination is unusual, and the approach is advocated for use with other health professions.

Clinical Competence↗

PubMed1987

Clinical ladders: do they serve their purpose?

Clinical ladders may benefit the needs of hospitals and occasionally the needs of individual nurses, but do they meet our professional need to recognize clinical excellence in nursing? Analysis of this issue and its impact on nursing is presented through review of pertinent literature. Conceptual and structural frameworks currently used in clinical ladder programs are discussed. The author then presents a promotional model more appropriate to the needs of nurses and nursing.

Career Mobility↗

PubMedDate not supplied

Respectful service and reverent obedience. A Jewish view on making decisions for incompetent parents.

Too often, caregivers and ethicists misunderstand the motivations of adult children who are involved in the care of their parents. They sometimes fail to appreciate the ways in which adult children may be trying to carry out their filial obligations toward a parent, obligations dictated by their religious commitments. Exploring these obligations within the Jewish tradition can help illuminate these issues and provide an alternative to a rights-based framework in which to reason about them.

Adult↗

PubMed1996

The professional socialization of dental hygienists: from dental auxiliary to professional colleague.

Dental hygiene, as an emerging profession, has identified key attributes and attitudes of the professional socialization process that are necessary to a continued growth and ability of its members to serve the needs of the public. Restraints to the professionalization process have been identified as impeding both the growth of dental hygienists and confining the delivery of dental hygiene services to traditional and supervised settings. Research has demonstrated the educational preparation of both the baccalaureate and associate/certificate degree dental hygienist can provide the opportunity for professional socialization whereby the care provider attains those attitudes deemed necessary to practice in a professional mode. Studies have also indicated that dental hygienists favor full professional status for dental hygiene through support for self-regulation and autonomy. In the light of health care reform, full utilization of all members of the health care team will be the most prudent use of health care funds. As dental hygiene emerges as a profession, registered hygienists will need to identify and define the conceptual framework for the oral hygiene practice of the future.

Attitude of Health Personnel↗

PubMed2006

Reflection: a critical proficiency essential to the effective development of a high competence in communication.

Reflection, or the ability to step back from an experience and consider it critically, in an analytical, non-subjective manner, is an essential aspect of problem solving and decision making, and also of effective communication with clients and colleagues. Reflective practice has been described as the essence of professionalism and is therefore a core professional skill; rarely, however, has it been explicitly taught in veterinary curricula, and it has only a recent history in undergraduate human medical curricula. We describe here two preliminary case studies, one in a veterinary medical education context and the other within a human medical education framework, as examples of approaches to assessing a student's ability for ''reflection.'' The case studies also illustrate some of the key principles. Both of the case studies described had as their end goal the enhancement of communication skills through critical reflection. At Monash University, Australia, the majority of students were assessed as being at a level of ''reflection in development.'' The students in the Ontario Veterinary College case study showed moderately good use of self-awareness and critical reflection as a basis for modifying and integrating communication skills into practice. While both preliminary case studies point to the fact that students recognize the importance of communication and value the opportunity to practice it, few students in either case study identified the importance of reflection for lifelong learning and professional competence. Opportunities to complete critical reflection exercises in other parts of curricula and outside of communication would likely reinforce its importance as a generic skill. Ongoing scholarly approaches to teaching, learning, and evaluating reflection and self-awareness are needed.

Cognition↗

PubMed1980

A conceptual framework for teaching geriatrics in a family medicine residency.

There is increasing recognition of the need for educational programs in geriatric medicine, a previously neglected area of medical education. Such training is particularly important in family medicine residencies because primary care physicians have provided the bulk of health care to the elderly and probably will continue to do so. There are many advantages to using a competency-based curriculum model in developing such an educational program in geriatric medicine. The competency-based model clearly states educational objectives and identifies pertinent instructional resources and evaluation methods. A competency-based curriculum model is described which divides competencies under four major goals: understanding principles of geriatric medicine, obtaining and interpreting data, managing geriatric patients, and working as a member of a health care team. Sample objectives for each goal are described, and experience using this model in a family residency is reviewed.

Competency-Based Education↗

PubMed1993

The competing discourses of HIV/AIDS in sub-Saharan Africa: discourses of rights and empowerment vs discourses of control and exclusion.

The competing discourses of HIV/AIDS circulating in sub-Saharan Africa are identified. These are medical, medico-moral, developmental (distinguishing between 'women in development' and gender and development perspectives), legal, ethical, and the rights discourse of groups living with HIV/AIDS and of African pressure groups. The analytical framework is that of discourse analysis as exemplified by Michel Foucault. The medical and medico-moral are identified as dominant. They shape the perceptions of the pandemic, our responses to it, and to those living with HIV/AIDS. However, dissident activist voices are fracturing the dominant frameworks, and are mobilising a struggle for meaning around definitions of gender, rights, and development.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

A framework for advanced practice nursing.

The empirical and expository literatures about advanced nursing practice have lacked a broad, comprehensive, conceptual framework to organize and guide substantive work. Such a framework is needed during the development of health care policy, educational curricula, role descriptions, and research agendas for this arena of practice. The framework proposed in this article represents an integrative synthesis of previous work on advanced nursing practice. The proposed framework is based on the definition of advanced practice nursing as professional health care activities that (1) focus on clinical services rendered at the nurse-client interface, (2) use a nursing orientation, (3) have a defined but dynamic and evolving scope, and (4) are based on competencies that are acquired through graduate nursing education. Advanced practice nursing is comprised of activities in the domains of advanced clinical practice, health care systems management, and professional involvement in broad health care discourse.

Curriculum↗

PubMed2004

Long-term sustainability of reductive dechlorination reactions at chlorinated solvents sites.

The sustainability of biodegradation reactions is of interest at Type 1 chlorinated solvent sites where monitored natural attenuation is being considered as a remedial alternative. Type 1 chlorinated solvent sites are sites undergoing reductive dechlorination where anthropogenic substrates (such as landfill leachate or fermentable organics in the waste materials) ferment to produce hydrogen, a key electron donor. A framework is provided that classifies Type 1 chlorinated solvent sites based on the relative amounts and the depletion rates of the electron donors and the electron acceptors (i.e., chlorinated solvents). Expressions are presented for estimating the total electron donor demand due to the presence of solvents and competing electron acceptors such as dissolved oxygen, nitrate, and sulfate. Finally, a database of 13 chlorinated solvent sites was analyzed to estimate the median and maximum mass discharge rate for dissolved oxygen, nitrate, and sulfate flowing into chlorinated solvent plumes. These values were then used to calculate the amount of hydrogen equivalents and potential for lost perchloroethylene (PCE) biodegradation represented by the inflow of these competing electron acceptors. The median and maximum mass of PCE biodegradation lost due to competing electron acceptors, assuming 100% efficiency, was 226 and 4621 kg year(-1), respectively.

Biodegradation, Environmental↗

PubMed2004

Cultivating expertise in informal reasoning.

People generally develop some degree of competence in general informal reasoning and argument skills, but how do they go beyond this to attain higher expertise? Ericsson has proposed that high-level expertise in a variety of domains is cultivated through a specific type of practice, referred to as "deliberate practice." Applying this framework yields the empirical hypothesis that high-level expertise in informal reasoning is the outcome of extensive, deliberate practice. This paper reports results from two studies evaluating the hypothesis. University student participants completed 12 weeks of deliberate practice in informal reasoning. Quantity of practice was recorded by computer, and additionally assessed via self-report. The hypothesis was supported: Students in both studies showed a large improvement, and practice, as measured by computer, was related to amount of improvement in informal reasoning. These findings support adopting a deliberate practice approach when attempting to teach or learn expertise in informal reasoning.

Adult↗

PubMed2006

Interpreting anonymous DNA samples from mass disasters--probabilistic forensic inference using genetic markers.

MOTIVATION: The problem of identifying victims in a mass disaster using DNA fingerprints involves a scale of computation that requires efficient and accurate algorithms. In a typical scenario there are hundreds of samples taken from remains that must be matched to the pedigrees of the alleged victim's surviving relatives. Moreover the samples are often degraded due to heat and exposure. To develop a competent method for this type of forensic inference problem, the complicated quality issues of DNA typing need to be handled appropriately, the matches between every sample and every family must be considered, and the confidence of matches need to be provided. RESULTS: We present a unified probabilistic framework that efficiently clusters samples, conservatively eliminates implausible sample-pedigree pairings, and handles both degraded samples (missing values) and experimental errors in producing and/or reading a genotype. We present a method that confidently exclude forensically unambiguous sample-family matches from the large hypothesis space of candidate matches, based on posterior probabilistic inference. Due to the high confidentiality of disaster DNA data, simulation experiments are commonly performed and used here for validation. Our framework is shown to be robust to these errors at levels typical in real applications. Furthermore, the flexibility in the probabilistic models makes it possible to extend this framework to include other biological factors such as interdependent markers, mitochondrial sequences, and blood type. AVAILABILITY: The software and data sets are available from the authors upon request.

Algorithms↗

PubMed2004

Primary-consistent soft-decision color demosaicking for digital cameras (patent pending).

Color mosaic sampling schemes are widely used in digital cameras. Given the resolution of CCD sensor arrays, the image quality of digital cameras using mosaic sampling largely depends on the performance of the color demosaicking process. A common problem with existing color demosaicking algorithms is an inconsistency of sample interpolations in different primary color channels, which is the cause of the most objectionable color artifacts. To cure the problem, we propose a new primary-consistent soft-decision framework (PCSD) of color demosaicking. In the PCSD framework, we make multiple estimates of a missing color sample under different hypotheses on edge or texture directions. The estimates are made via a primary consistent interpolation, meaning that all three primary components of a color are interpolated in the same direction. The final estimate of a color sample is obtained by testing different interpolation hypotheses in the reconstructed full-resolution color image and selecting the best via an optimal statistical decision or inference process. A concrete color demosaicking method of the PCSD framework is presented. This new method eliminates certain types of color artifacts of existing color demosaicking methods. Extensive experimental results demonstrate that the PCSD approach can significantly improve the image quality of digital cameras in both subjective and objective measures. In some instances, our gain over the competing methods can be as much as 7 dB.

Algorithms↗