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PubMedDate not supplied

A five-step "microskills" model of clinical teaching.

Teaching family practice residents in a clinical setting is a complex and challenging endeavor, especially for community family physicians teaching part-time and junior faculty members beginning their academic careers. We present a five-step model of clinical teaching that utilizes simple, discrete teaching behaviors or "microskills." The five microskills that make up the model are (1) get a commitment, (2) probe for supporting evidence, (3) teach general rules, (4) reinforce what was done right, and (5) correct mistakes. The microskills are easy to learn and can be readily used as a framework for most clinical teaching encounters. The model has been well received by both community family physicians interested in teaching and newer residency faculty members.

Clinical Competence↗

PubMed1993

The assessment center: evaluating managerial potential.

This assessment center helps unit directors critique their own managerial strengths and weaknesses and formulate effective self-improvement plans and growth strategies. Structured activities also provide a framework for administrators to identify managerial talent and to develop potential nurse managers effectively.

Administrative Personnel↗

PubMed1997

The adequacy of nurse staffing.

The JCAHO advises that staffing changes, with or without restructuring, should include a framework for improving patient care. This article explores such a framework, as well as addressing common questions about staffing. Both the JCAHO and Nursing Management's editors urge you, the readers, to submit your questions (see address at the end of the column).

Clinical Competence↗

PubMed2001

Mothers' evolving relationships with doctors and nurses during the chronic childhood illness trajectory.

AIMS: In this paper the evolution of mothers' relationships with doctors and nurses during the chronic childhood illness trajectory is explored and discussed and the implications for child health care are considered. The discussion reports one aspect of a qualitative study that sought to determine whether time of diagnosis influenced mothers' coping across the illness trajectory. BACKGROUND: The quality of relationships between mothers, who are usually the primary carers, and nursing and medical staff is central to the experience of coping with chronic childhood illness. Mothers need to develop expertise in a wide range of technical skills and knowledge of complex health care issues, while also coming to terms with the uncertainty of a condition with an unpredictable trajectory. Attempts to understand the significance of relationships between those living with chronic illness and staff have highlighted a number of factors that may influence the degree to which they are viewed as satisfactory. The way staff communicate with families has been identified as one of the mediating processes through which the quality of such is determined. DESIGN: Mothers of 15 children diagnosed presymptomatically and 14 children diagnosed postsymptomatically with the chronic illness Vesicoureteric Reflux (VUR) were interviewed to assess and compare coping strategies across the trajectory. Mothers' written consent was obtained and interviews were tape-recorded, transcribed and analysed using the 'Framework Technique'. FINDINGS AND CONCLUSION: The need to develop and sustain trusting relationships with staff was reported as a continual source of stress for mothers. The formation of satisfactory alliances, based on mutual respect and good communication early in the trajectory, in particular during the prediagnostic phase, was found to be instrumental in coping and competence development during the later chronic phase of the trajectory. Further research is needed to map prospectively the evolution of relationships between mothers and staff across the trajectory.

Adaptation, Psychological↗

PubMedDate not supplied

Factors affecting parenting stress among biologically vulnerable toddlers.

Parenting a child with, or at risk for, a developmental delay or disability can be stressful. Abidin's parenting stress model was used as a framework to examine how several maternal, child, and family factors predict parent stress outcomes. Stepwise regression models revealed that maternal and child factors were significant contributors to parenting stress. However, family factors (income and family functioning) were not retained. Parenting stress was lower when child (cognitive and adaptive ability) and maternal (depression and child care competence) characteristics were more positive. Child cognitive ability was a strong contributor to total parenting stress and two parenting stress subscales. Findings suggest that these parents need stress lowering interventions such as supportive child care, respite relief, and a child behaviour-focused program.

Adaptation, Psychological↗

PubMed2006

Classroom goal structure, student motivation, and academic achievement.

Over the past 25 years, achievement goal theory has emerged as one of the most prominent theories of achievement motivation. This chapter uses an achievement goal framework to examine the influence of classroom and school environments on students' academic motivation and achievement. Considerable evidence suggests that elementary and secondary students show the most positive motivation and learning patterns when their school settings emphasize mastery, understanding, and improving skills and knowledge. Whereas school environments that are focused on demonstrating high ability and competing for grades can increase the academic performance of some students, research suggests that many young people experience diminished motivation under these conditions. The implications of achievement goal theory for examining the impact of school reform are discussed.

Achievement↗

PubMed2003

Anthropological assessment for culturally appropriate interventions targeting men who have sex with men.

Although social and cultural factors play a fundamental role in the health of sexual minority populations and the development of culturally appropriate interventions, public health activities and research have sometimes lacked appropriate sophistication or attention to issues of cultural competency. In areas such as HIV prevention for men who have sex with men (MSM), biomedical interpretations of same-sex phenomena should be applied with caution. Communities and societies may broadly understand same-sex desire, attraction, behavior, and identity through age-structured/initiatory, gender-defined, profession/social role-defined, or egalitarian/gay frameworks. When more detailed, locally specific information is required, such as for youth, ethnic minorities, or urban versus rural populations, the approach to rapid anthropological assessment presented can provide nuanced insights for effective health programs targeting MSM.

Anthropology, Cultural↗

PubMed2006

The role and functionality of Veterinary Services in food safety throughout the food chain.

Both national Veterinary Services and international standard-setting organisations have now embraced risk assessment as an essential tool for achieving their goals. Veterinarians have key roles in all aspects of the control of food-borne hazards of animal origin, but additional specialist skills are necessary for assessing, managing and communicating risk. Further, the deployment of Veterinary Services must reflect the multi-functional aspects of public and animal health activities. A generic risk management framework provides a systematic process whereby food safety standards and other measures are chosen and implemented on the basis of knowledge of risk and evaluation of other factors relevant to protecting human health and promoting non-discriminatory trade practices. In this context, a number of countries are exploring new administrative and structural arrangements for competent authorities. The traditional focus of veterinary involvement in food safety has been in meat hygiene at the level of the slaughterhouse. While this role continues, the emerging 'risk-based' approach to food control requires increased involvement in other segments of the meat food chain, as well as other areas such as production of milk and fish. This more extensive role requires a wider skill base and establishment of effective networks with a different range of stakeholders.

Animal Welfare↗

PubMed2004

A conceptual framework for adaptive preventive interventions.

Recently, adaptive interventions have emerged as a new perspective on prevention and treatment. Adaptive interventions resemble clinical practice in that different dosages of certain prevention or treatment components are assigned to different individuals, and/or within individuals across time, with dosage varying in response to the intervention needs of individuals. To determine intervention need and thus assign dosage, adaptive interventions use prespecified decision rules based on each participant's values on key characteristics, called tailoring variables. In this paper, we offer a conceptual framework for adaptive interventions, discuss principles underlying the design and evaluation of such interventions, and review some areas where additional research is needed.

Child↗

PubMed2002

Forensic psychiatric nursing: a literature review and thematic analysis of role tensions.

This literature review was undertaken to explore the emergent issues relating to the difficulties encountered in forensic psychiatric nursing. The rationale for the study revolved around the paucity of research undertaken to identify the constituent parts of this professional practice. The aims included both a thematic analysis of the literature and the construction of a theoretical framework to guide further research. The method was a snowballing collection of literature and a computerized database search. The results were the identification of a series of major issues, which were broadly categorized as negative and positive views, security vs. therapy, management of violence, therapeutic efficacy, training and cultural formation. From this the six binary oppositions, or domains of practice, emerged as a theoretical framework to develop further research. These were medical vs. lay knowledge, transference vs. counter-transference, win vs. lose, success vs. failure, use vs. abuse, and confidence vs. fear. Further research is currently underway.

Clinical Competence↗

PubMed2004

Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment.

OBJECTIVE: The authors, in collaboration with NSW Health, have recently developed a comprehensive suicide risk assessment framework. The present paper describes key concepts in the assessment of suicide risk by mental health professionals. METHODS: A framework for conducting a comprehensive suicide risk assessment was derived from the literature, incident analysis and clinical experience. The framework underwent a consultation process involving clinicians in NSW area mental health services. The aim was to provide clinicians with a standardized conceptual map for the assessment of suicide risk. A MEDLINE search was conducted for publications dealing with 'suicide' and 'suicide risk assessment' from 1980 to 2002. The recommendations from sentinel event reviews conducted in a NSW area mental health service in the period 1999-2002 were reviewed. The lessons from a visit to a coroner's relatives support group for people who had been bereaved by suicide also informed the development of the guidelines. RESULTS: A framework is proposed for the assessment of suicide risk. The framework promotes a reflective style of practice, encouraging clinicians to evaluate their assessment and its limitations. Risk assessment is always undertaken as part of a full clinical assessment and an evaluation of the person's current predicament and psychosocio-cultural context. The concepts of changeability, assessment confidence, common sense and the importance of corroboration are incorporated in the framework. CONCLUSIONS: Mental health clinicians can be guided by a framework in suicide risk assessment and documentation. The assessment of suicide risk can generate a suicide risk rating for which minimum standards of care can be mandated.

Clinical Competence↗

PubMed2002

Using the American Board of Internal Medicine's "Elements of Professionalism" for undergraduate ethics education.

PURPOSE: To examine the feasibility of using the taxonomy of professional and unprofessional behaviors presented in the American Board of Internal Medicine's (ABIM's) Project Professionalism to categorize ethical issues that undergraduate medical students perceive to be salient. METHOD: Beginning second-year medical students at the University of Washington School of Medicine (n = 120) were asked to respond to three open-ended questions about professional standards of conduct and peer evaluation. Two of the authors read and coded the students' responses according to the ABIM's elements of professionalism (altruism, accountability, excellence, duty, honor and integrity, and respect for others) and the challenges to those elements (abuse of power, arrogance, greed, misrepresentation, impairment, lack of conscientiousness, and conflict of interest). Coding disagreements were solved using review and revision of the category definitions. New categories were created for students' responses that described behaviors or issues that were not captured in the ABIM's categories. RESULTS: A total of 114 students responded. The ABIM's professional code was adapted for students and teachers, making it context- and learning-stage-specific. One new category of challenges, conflicts of conscience, was added, and one category (abuse of power) was expanded to include abuse of power/negotiating power asymmetries. CONCLUSIONS: Using the ABIM's taxonomy to name professional and unprofessional behaviors was particularly useful for examining undergraduate medical students' perceptions of the ethical climate for learning during the first year of medical school, and it holds promise for research into changes in students' perceptions as they move into clinical experiences. Using the framework, students can build a unified professional knowledge-and-skills base.

Behavior↗

PubMed1976

Social theory and medicine.

Three sociolgists-Talcott Parson, Eliot Freidson, and Mechanic-have explained medical phneomena within a broader theoretical framework. Although all three have made significant contributions, their conclusions remain incomplete on the theoretical level and seldom have been helpful for workers concerned with ongoing problems of health care. Our purpose here is to summarize some of the strengths and weakness of each theoretical position. Parsons has elucidated the sick role as a deviant role in society, the function of physicians as agents of social control, and the normative patterns governing the doctor-patient relationship. The principal problems in Parsons' analysis center on an uncritical acceptance of physicians' social control functions, his inattention tot the ways in which physicians' behavior may inhibit change in society, and overoptimism about the medical profession's ability to regulate itself and to prevent the exploitation of patients. Viewing medical phenomena within a broader theory of the professions in general, Freidson has formulated w wide ranging critique of the medical profession and professional dominance. On the other hand, Freidson's work neglects the full political implications of bringing professional autonomy under control. Mechanic's coceptual approach emphasizes the social psychologic factors, rather than the institutional conditions, which are involved in the genesis of illness behavior. Mechanic also overlooks the ways in which illness behavior, by permitting a controllable from of deviance, fosters institutional stability. In conclusion, we present a breif overview of a theoretical framework whose general orientation is that of Marixian analysis. Several themes recur in this framework: illness as a source of exploitation, the sick role as a conservative mechanism fostering social stability, stratification in medicine, and the imperialsm of large medical institutions and health-related industries.

Clinical Competence↗

PubMed1999

Developing critical appraisal skills.

Critical appraisal is used to evaluate research and determine whether it should be incorporated into the reader's area of practice. Checklists are used in critical appraisal to provide a useful framework for the systematic analysis of research studies. Critical appraisal skills can be acquired in a number of ways, and can even be self-taught.

Humans↗

PubMed1994

Clinical preceptorships: strategies to enhance teaching and learning.

This article focuses on the practical aspects of clinical teaching. The teacher, preceptor, and mentor roles are defined and developed within the framework of adult learning principles. Guidelines for determining learning goals, choosing learning activities, facilitating learning during clinical practice, and evaluating knowledge and skill levels of both novice and experienced practitioners are included.

Clinical Competence↗

PubMedDate not supplied

Developing healthcare educators. The application of a conceptual model.

The staff development faculty is a unique group of educators who are at the very core of processes in today's healthcare environment. Even so, little guidance is available for their professional development from novice to expert. The conceptual model presented in this article defines a developmental continuum for healthcare staff educators. The model serves as a comprehensive framework to guide staff development activities from initial orientation to educational opportunities that lead to the expert role.

Education, Nursing, Continuing↗

PubMed1996

A patient-specific in vivo tumor model.

A significant body of research, spanning approximately the last 25 years, has focused upon the task of developing a better understanding of tumor growth through the use of in vitro mathematical models. Although such models are useful for simulation, in vivo growth differs in significant ways due to the variety of competing biological, biochemical, and mechanical factors present in a living biological system. An in vivo, macroscopic, primary brain tumor growth model is developed, incorporating previous in vitro growth pattern research as well as scientific investigations into the biological and biochemical factors that affect in vivo neoplastic growth. The tumor growth potential model presents an integrated, universal framework that can be employed to predict the direction and extent of spread of a primary brain tumor with respect to time for a specific patient. This framework may be extended as necessary to include the results of current and future research into parameters affecting neoplastic proliferation. The patient-specific primary brain tumor growth model is expected to have multiple clinical uses, including: predictive modeling, tumor boundary delineation, growth pattern research, improved radiation surgery planning, and expert diagnostic assistance.

Biomechanical Phenomena↗

PubMed2001

[Skelefon framework concept for defence against risks in unusual epidemics: steps by public health offices].

Necessary anti-epidemic measures have to be promulgated or taken immediately in case of a suspected case of pneumonic plague or a viral haemorrhagic fever which can be transmitted from human to human. A live threatening highly contagious infectious disease may occur at any place in Germany. Therefore each health office should have the relevant information on the available infrastructure in Germany concerning treatment and competence centres, diagnostic laboratories, dispatch of samples and patient transportation. They should also be able to give qualified recommendations to physicians and hospitals concerning the necessary measures in such a case. Contacts at risk have to be notified. Based on a risk assessment and the special living conditions of the contact person they should decide if and which further measures have to be initiated, especially in the case of post-exposure prophylaxis, separation and prohibition of work. In general, imported cases of dangerous infectious diseases quickly find the interest of the media, including all the implications resulting from this. A well-organized cooperation with the media and public relations helps to avoid unnecessary irritations and panic.

Communicable Disease Control↗