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PubMed2002

Web journaling. Using informational technology to teach reflective practice.

Reflection is a process by which we think about experiences and relieve them. Web journaling is a tool that gives students opportunities to use reflection when they are away from the immediate clinical environment. Through such reflection the student's personal knowledge that informs their practice is revealed. The revelation of personal knowledge is key to structuring subsequent faculty guidance. The web journal is a vehicle for student/faculty dialogue aimed at expanding both the faculty's responses to students' learning needs and the students' responses to persons in their care. Questions formulated in the dialogue direct the student's web-based search for new information. Faculty guidance subsequently focuses on the student's decisions regarding the use of information to direct clinical practice. Web journaling done over several nursing courses reinforces a model of learning, which is increasingly more deliberative and intentional. Web journaling may contribute to the development of practice throughout a nursing career because it becomes a way for self-directed learning.

Attitude of Health Personnel↗

PubMed2003

Does time use in outpatient residency training reflect community practice?

BACKGROUND: The degree to which the ideals practiced during residency training persist amidst the pressures of community practice is unknown. Therefore, this paper compares time use during outpatient visits to family practice residents and experienced family physicians. METHODS: Visits of 244 new adult outpatients to 33 second- and third-year residents in a university clinic in Northern California were compared to 277 new adult outpatient visits to 92 community family physicians in Northeast Ohio, using the Davis Observation Code (DOC). The DOC uses observation to classify visit time into 20 different behavioral categories, reflecting different physician styles of interaction with patients. RESULTS: Controlling for patient mix, residents had longer visits, a less technical focus, and spent a greater percent of the visit on efforts to promote health behavior change, patient activation, preventive services, discussion of substance abuse, and counseling. CONCLUSIONS: Experienced family physicians provide more technical and less preventive and psychosocially oriented care than residents. This may reflect differences in patient mix, practice setting, physician experience, and the time and financial pressures of community practice. These findings may be used to modify residency training to better reflect actual community practice and to guide future studies of the effects of experience and different practice environments on physician style with patients.

Ambulatory Care↗

PubMed2000

[Comparison of FTIR microspectroscopy and diffuse reflectance spectroscopy for monitor of solid phase reaction].

17 FTIR micro transmission spectra of single resin beads of each sample, from polystyrene sulfonyl chloride resin changing to polystyrene sulfonyl amide resin in solid-phase reaction in water at 0 degree C, 20 degrees C, 40 degrees C, 60 degrees C, were recorded. The reaction was monitored by the means of FTIR microspectroscopy and diffuse reflectance spectroscopy upon the products. It was showed that the pressed single bead as a piece of biscuit was able to give higher quality spectrum. In comparison, 8 diffuse reflectance spectra of each sample were also collected. It seems that the diffuse reflectance spectroscopy is a more easy dealing with and effective method to control the whole reaction. However, the microspectroscopy is the first choice to check the difference between resin beads.

Ion Exchange Resins↗

PubMed1992

[The effect of peripheral reflections on the left ventricle].

In order to evaluate the effect of modifications in reflections timing on the ventricular performance, 10 isolated rabbit hearts were connected to rubber tubes of different lengths (0.5, 0.8, 1.0, 2.5 m) with terminal stopper and 2 cylindric small tubes as constant hydraulic resistance. The terminal connection produced wide reflections which returned to the ventricle in early, mid, late systole and in the diastolic phase (2.5 m). Ventricular and aortic pressure, and aortic flow were continuously recorded, sampled and stored on a personal computer. Instantaneous and total systolic ventricular work and stroke volume were calculated using an automatic procedure. Mean coronary perfusion pressure was calculated as difference between aortic and ventricular pressure in diastolic phase. The results demonstrate an important modification of the ventricular performance related to the anticipation of the reflected pulse. The anticipation produces a decrease in the stroke volume (-14.5%), a decrease in the external work of the ventricle (-21%) and a decrease in mean coronary perfusion pressure (-28%). The first two parameters describe the performance of the pump with respect to the load, and the third evaluates the perfusion of the pump itself. Reported to the clinical situation, these results demonstrate that an increased stiffness of the aorta has a double negative effect, a decrease in cardiac output and in external ventricular work, and moreover a decrease in coronary pressure, which produces a reduction of coronary flow.

Animals↗

PubMed2003

Different influences on central and peripheral pulse pressure, aortic wave reflections and pulse wave velocity of three different types of antihypertensive drugs.

OBJECTIVE: To evaluate in hypertensive patients (pts) with similar peripheral blood pressure (BP) whether different antihypertensive treatments have different influences on aortic stiffness, aortic central pressures and aortic wave reflections. METHODS: In a cross-over study 41 nondiabetic hypertensives (21 women, age 35-60 yrs) were evaluated after stabilized (> 4 months) antihypertensive treatment and with casual BP between 130/80 and 160/95 mmHg. Patients were divided into 3 groups: Group I--12 pts all medicated with beta-blockers; Group II--14 pts all medicated with calcium channel blockers; Group III--15 pts all medicated with either angiotensin-converting enzyme inhibitors (ACEIs) (n = 8) or angiotensin II receptor blockers (ARBs) (n = 7). We evaluated casual BP and carotid-femoral pulse wave velocity (PWV). Systolic blood pressure (SBP) and pulse pressure (PP), left ventricular ejection duration (LVED), augmentation pressure (delta P) and augmentation index (AI%) in the aorta (a measure of aortic wave reflection), derived using radial and carotid applantation tonometry, were measured. Data are means + SEM. RESULTS: For similar casual peripheral BP values, group III vs. group I showed lower (p < 0.05) values of: aortic stiffness--PWV (10.3 +/- 0.2 vs. 11.2 +/- 0.3 m/s), central PP (48 +/- 2 vs. 55 +/- 2 mmHg), delta TP (11 +/- 3 vs. 21 +/- 3 mmHg), LVED (297 +/- 5 vs. 319 +/- 8 ms), AI% (22 +/- 4 vs. 39 +/- 3%), suggesting reduced vascular tone in the arteries and greater brachial-aortic PP amplification. Data in group II did not differ significantly from the other two groups. CONCLUSIONS: Independently of casual BP values, the three classes of antihypertensive drugs appear to have different influences on aortic stiffness, central pressures and aortic wave reflections, ACEIs or ARBs appearing to exhibit a more favorable profile.

Adult↗

PubMed2004

[Study of sensory memory reflected by mismatch negativity and its clinical application].

The event-related brain potential called Mismatch negativity (MMN) reflects the auditory detection system which automatically detects subtle change in the surrounding acoustic environment. This system is based on the pre-attentive mechanism of comparison mechanism between the neural trace of background sounds stored in sensory memory and incoming sound change. This "memory trace theory" has raised the importance of MMN. The features of sound information are extracted from the incoming sound in sensory memory, and is integrated into an auditory unit within the temporal window of 160-170 ms. Since the MMN itself is basically free from the influence of attention and requires no task for measurement, MMN can be applied to various clinical studies. There are two generators, the temporal MMN reflecting the change detection in sensory memory and the frontal MMN reflecting the attentional switch. Therefore, MMN has various clinical applications including memory disturbance and attention disorder. For example, reduced amplitude of MMN is a robust finding in schizophrenia. Some basic MMN studies and their promising clinical applications are described here.

Acoustic Stimulation↗

PubMed2003

[Reflections on the child being and on the nursing care in AIDS context].

This article is the result of reflections on the study carried out for the completion of the Nursing School at the Federal University of Santa Maria-RS, Brazil. It relates to the Nursing Care on Health Education to the child being that lives with the HIV/AIDS and was developed at the Pediatric Infectious Disease Service of Santa Maria University Hospital-RS, Brazil. Trying to find subsidies in order to make a reflection on the child-being, one resorted to the Humanistic Nursing Theory by Paterson and Zderad that enlightened the followed way, and provided a reflection on the Nursing knowledge, its purpose and its direction in the care science.

Acquired Immunodeficiency Syndrome↗

PubMed2004

The use of critical reflection in baccalaureate nursing education.

Leaders in nursing education are incorporating innovative educational strategies, including reflection, which will more fully develop student nurses' intellectual capacities to conceptualize knowledge to better meet patients' needs (Boud, Keough, & Walker, 1998; Duraghee, 1996; Hallett, 1997). This article examines the theoretical basis for reflective practice and explores its usefulness in the development and transmission of nursing knowledge in baccalaureate nursing education. Critical reflection can be effectively utilized by leaders in baccalaureate nursing education in classrooms, clinical settings, service learning experiences, experiential learning activities, and in the instruction of ethical decision-making.

Attitude of Health Personnel↗

PubMedDate not supplied

Using focused reflection and articulation to promote clinical reasoning: an evidence-based teaching strategy.

This research explored the effects of instructing first-semester nursing students in the use of focused reflection and articulation to promote clinical reasoning. Student volunteers were randomly assigned to four clinical groups. Two groups that received instruction in the use of focused reflection and articulation scored significantly higher on the practice measure of clinical reasoning, accounting for 29 percent of the variance between groups. Once clinical reasoning scores were tabulated, the top six and bottom six scorers on clinical reasoning were interviewed to identify qualitative differences between students with different reasoning levels. Themes from the interviews revealed that those with high clinical reasoning reported a high frequency of use of focused reflection and articulation, engaged in abstract learning, and were more self-regulated in their learning than those who scored low on clinical reasoning. This study provides empirical evidence that using instructional methods that focus learners' attention on the concrete application of theory in the practicum setting helps enhance their reasoning skills.

Analysis of Variance↗

PubMed2005

Interprofessional relationships and collaborative working: encouraging reflective practice.

A challenge for those involved in the education and professional development of health and social care practitioners is to find ways of encouraging and enabling them to critically reflect upon complex collaborative situations and consider how they might improve interprofessional relationships. To meet this challenge, we piloted and developed a reflective exercise derived from methods used in personal construct psychology (Hargreaves,1979; Salmon,1994), which has proved to be useful in three overlapping areas; research, professional development, and classroom teaching. To illustrate the technique, this paper presents a case study of one district nurse who used the method to help her examine complex interprofessional relationships when providing long-term community care. The reflective technique (which uses arrow-shaped cards displayed on large visual layouts) was found to provide a rich description of the individual's relationships. By employing the visual displays the district nurse was able to explore the meanings of professional identity and roles in terms of professional relationships, and to consider her intentions and actions within a complex multidisciplinary situation.

Cooperative Behavior↗

PubMed2005

Enhancing patient-based learning: introducing STRAC and the reflective history template.

The University of New South Wales School of Rural Health, Australia, like many other rural clinical schools, relies heavily on patient-based learning which is largely serendipitous. The learning is not driven by courses of lectures but by the patients who become available in a variety of settings. Students, who, in their first 3 years have been exposed to a very structured didactic learning experience, start their rural experience in Year IV with a curriculum mainly concerned with general medicine and surgery. They have to learn to adapt to a largely self-directed model. While their rural clinical experience is very much broader than that of their city-based peers, an excellent feature, it engenders feelings of insecurity and a perceived need for students and faculty to have a method of tracking patient encounters so they can ensure the syllabus is covered. Early attempts with a paper-based system and later a Reflective Learning Diary proved unsuccessful. This article presents Syllabus Tracking (STRAC) together with a Reflective Case History Template which encourages reflective learning from patients encountered. STRAC is a web-based solution that includes a reporting function, and is easily modified to suit the needs of the curriculum. It is believed it may also prove useful for future applications. Most rural clinical schools in Australia are young, as are these tools. They are not formally evaluated but are offered to other schools as a suggestion.

Curriculum↗

PubMedDate not supplied

The feasibility of spectrophotometric measurements of arterial oxygen saturation from the fetal scalp utilizing noninvasive skin-reflectance pulse oximetry.

In in-vivo animal experiments, the authors evaluated the feasibility of measuring arterial oxyhemoglobin saturation (SaO2) noninvasively during simulated delivery conditions with a skin-reflectance pulse oximeter sensor attached to the fetal scalp. The optical reflectance sensor consisted of three pairs of red and infrared light-emitting diodes and a concentric array of six identical photodiodes. Two prototype sensor assemblies, incorporating different means of attachment to the scalp, were evaluated. Each sensor was interfaced to a commercial Datascope ACCUSTAT transmittance pulse oximeter, adapted to perform as a reflectance pulse oximeter. This method, once successfully developed, could potentially be used in combination with other fetal monitoring techniques to elucidate the role of noninvasive pulse oximetry in reducing fetal morbidity and mortality.

Animals↗

PubMed2005

Association of importance of the doctoral degree with students' perceptions and anticipated activities reflecting professionalism.

BACKGROUND AND PURPOSE: The American Physical Therapy Association (APTA) has identified the Doctor of Physical Therapy (DPT) degree as 1 of 6 elements necessary to transition the physical therapy profession to a fully professionalized discipline. However, there have been no data to determine whether physical therapist students who place importance on the DPT degree perceive physical therapy to be more professionalized or anticipate participation in activities reflecting professionalism more than those who do not place importance on the DPT degree. SUBJECTS: The subjects were 919 professional physical therapist students. METHODS: Faculty members at 34 physical therapist education programs distributed questionnaires to 1,172 professional physical therapist students and returned 919 questionnaires, for a response rate of 78.4%. The data were statistically analyzed using chi-square analysis and logistic regression. RESULTS: There were few differences between students who place importance on the DPT degree (DPT-I students) and those who do not place importance on the DPT degree (DPT-NI students) regarding how professionalized they perceive physical therapy to be relative to other health care professions or regarding their anticipated participation in activities reflecting professionalism. The one potential distinction found when controlling for other variables was that DPT-I students were more likely than DPT-NI students to anticipate becoming faculty members. DISCUSSION AND CONCLUSION: When beginning their professional education, there are few differences between DPT-I and DPT-NI students' perceptions of the professionalization of physical therapy or anticipation of activities reflecting professionalism.

Attitude of Health Personnel↗

PubMedDate not supplied

Learning to become a nurse: students' reflections on their clinical experiences.

OBJECTIVE: To expose the significant events undergraduate student nurses reflect on during clinical experiences as they learn to become nurses. DESIGN: A qualitative study using reflective instruments of unstructured debriefing sessions and journal writing. SETTING: Conducted in a tertiary hospital in South-eastern Queensland, Australia. SUBJECTS: Forty voluntarily consenting students were involved. RESULTS: The findings of this study identify that students' interpretation of, and learning in the clinical context is influenced by: an interplay between the patient, registered nurse (RN) and the student's construction of themself as a nurse. Significant to the study and not previously identified is the way students enter the emotive life-world of the patient's experience. The study confirms that the RN makes a considerable difference to the student's experience. Furthermore, students begin to construct a personal identity of becoming a nurse through a process of developing confidence, confirmation of nursing practices and assimilating knowledge. CONCLUSION: Insights into what influences students learning in the clinical setting, how they interpret events and begin to build a repertoire of reflective exemplars provides clinical staff and educators with valuable information to design meaningful clinical learning experiences that will assist students to become nurses.

Clinical Competence↗

PubMedDate not supplied

Journal writing as a teaching technique to promote reflection.

OBJECTIVE: To introduce the process of journal writing to promote reflection and discuss the techniques and strategies to implement journal writing in an athletic training education curriculum. BACKGROUND: Journal writing can facilitate reflection and allow students to express feelings regarding their educational experiences. The format of this writing can vary depending on the students' needs and the instructor's goals. DESCRIPTION: Aspects of journal writing assignments are discussed, including different points to take into account before assigning the journals. Lastly, various factors to contemplate are presented when providing feedback to the students regarding their written entries. CLINICAL ADVANTAGES: Journal writing assignments can benefit students by enhancing reflection, facilitating critical thought, expressing feelings, and writing focused arguments. Journal writing can be adapted into a student's clinical course to assist with bridging the gap between classroom and clinical knowledge. In addition, journals can assist athletic training students with exploring different options for handling daily experiences.

Journal Article↗

PubMed2006

[Study of nanostructures and reflective spectra of porous alumina films].

Several chips of porous alumina films with different nanostructures and scales were prepared by using the method of anodic oxidation. An atomic force microscope (AFM) was employed to image the surfaces of alumina films, and the corresponding reflective spectra of them were acquired with a spectrometer. The experiments show that the alumina films with average pore diameters of 26 and 39 nm feature particular reflective spectra, each consisting of a periodic distribution of peaks and valleys within the wavelength range from 500 nm to 1000 nm. The density or the number of peaks and valleys was determined by the scales of nanostructures. The present paper discussed the relationship between the scale of nanostructures and the distribution of reflective spectra. Some satisfying explanations for them were presented.

English Abstract↗

PubMed1991

The acoustic reflection technique for non-invasive assessment of upper airway area.

Non-invasive assessment of upper airway area by acoustic reflections has been developed in the last 12 yrs. The technique is based on the analysis of sound waves reflected from the airways. Measurement of the amplitudes of the reflections and their times of arrival at the sensing microphone permits construction of a plot of airway area vs distance from the microphone. We describe the theoretical foundations of the method and review the underlying assumptions. This is followed by a summary of the results of in vitro and in vivo validation studies, with particular attention to the reproducibility, accuracy and variability of the technique. The description of clinical and physiological applications of this technique includes detection of tracheal stenosis, demonstration of structural and functional abnormalities of the pharynx and glottis in patients with sleep apnoea, dichotomous response of the airway area to exercise, and airway vs parenchymal hysteresis. Finally, we comment on the future directions that might be investigated using this technique.

Acoustics↗

PubMed1990

[Cerebral microcirculation during increased intracranial pressure--assessment with reflectance photometry].

The cerebral microcirculation under increased intracranial pressure was evaluated by using reflectance photometric method. The values of tissue hemoglobin (IHb) and its oxygen saturation (ISO2) detected by this method were evaluated in cat brain tissue. The correlation between IHb and content of cortical hemoglobin subunits in vitro was high. High correlation between ISO2 and blood oxygen saturation in superior sagittal sinus was also noted in hypoxic hypoxia. Thus, the reflectance photometric method was revealed to be applicable for evaluation of regional hemoglobin content and oxygen saturation. Using this method the cerebral microcirculation was studied in an increased intracranial pressure model produced by injection of artificial CSF into the cisterna magna in cats. Regional cortical cerebral blood flow (CBF) was measured simultaneously by thermal diffusion method. During decrease of perfusion pressure down to 40 mmHg with preservation of CBF, compensatory increase of IHb was not observed, but IHb rather gradually decreased. The decrease of IHb would be due collapse of capacitance vessels by increased intracranial pressure. Cerebral ISO2 was stable as well as CBF. Less than 40 mmHg of perfusion pressure, ISO2 started to decrease in association with CBF and IHb. Since ISO2 seems to be closely related to the tissue oxygen extraction the change of ISO2 reflect the CBF and tissue cerebral oxygen metabolism. Present study suggest the evaluations of IHb and ISO2 were an useful monitoring indexes in various cerebral disorders.

Animals↗