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Teaching ethics in nursing curricula. Traditional and contemporary models.

The teaching of ethics in nursing education has become increasingly important in recent years. While it was an important part of early nursing education, it nearly disappeared from the nursing curriculum during the 1950s and 1960s. The traditional method of ethics teaching, the Scientific Model, is no longer used in nursing education. However, the contemporary models of ethics teaching--the Moral Concepts Model, the Moral Issues Model, the Clinical Practice Model, and the Ethics Inquiry Model--are being implemented into baccalaureate, graduate, and doctoral education in nursing. Having different goals and employing different teaching methods, these models promise to achieve the overall goal for teaching ethics to nurses: to produce a morally accountable practitioner who is skilled in ethical decision making. The uses of these model are encouraged in all aspects of nursing education, regardless of type of curriculum and faculty preparation to teach ethics. Given the availability of ethics resources and faculty seminars/workshops on ethics teaching strategies, all or part of any of the models can be easily implemented in the majority of nursing education programs.

Bioethical Issues↗

Applicant selection procedures: a more objective approach to the interview process.

The applicant interview process is a valued component of the selection of students into the University of Colorado Medical Technology Program. However, problems related to the inherent subjectivity of the interview caused the faculty to investigate a more objective approach. A behaviorally anchored measurement instrument was developed and faculty rater training techniques were instituted to enhance objectivity and reliability. The new interview system performed measurably better than did its predecessor as demonstrated by higher reliability coefficients and a significant canonical correlation with a set of four student success variables. These outcomes are to be expected from the procedure used and demonstrate that careful design and implementation of an interview process will yield objective results that are reliable enough to predict student success.

Colorado↗

Patient nutrition education follow-up in the hospital setting.

Ideally, hospital patients should have the opportunity as outpatients for continued nutritional counseling by a dietitian or nutritionist. However, when this is not feasible, alternate methods can be developed to provide some follow-up and improve nutritional care. The outpatient nutrition education questionnaire is one such tool that can be implemented and utilized to give the patient an opportunity to ask for further help, while alerting the dietitian to patients needing further assistance.

Dietetics↗

Patient safety initiatives in Brazil: a nursing perspective.

The science development and technology application improvement in all areas of knowledge, including health care, represent an advance in patient care. The health care providers face challenges to accomplish complex procedures and treatments, which demand infrastructure, defined framework, constant process establishment and redesign of nursing care, based on a continuous outcomes evaluation. Therefore, this development requires nurses with advanced knowledge and skills. As the main health care provider in Brazilian hospitals, the nursing staff perform and control the majority of direct patient care procedures, and as such, nursing professionals can be responsible for triggering adverse events that can compromise patient safety. Research conducted in Brazil showed that the quality of health care delivery system and the results of care have significant variation nationwide. Health care professionals should be valued as the one who can promote patient safety, providing high quality care within cost-effective services. Technology is a key element to support and enhance the professional's performance. However, it is also important to promote and facilitate its implementation and development to retain a creative, engaged, skilled, satisfied, competent, and accountable professional capable of identifying and using technology resources in order to assure the quality of care for the population.

Adult↗

The United States Department of Energy's Regional Carbon Sequestration Partnerships program: a collaborative approach to carbon management.

This paper reviews the Regional Carbon Sequestration Partnerships (RCSP) concept, which is a first attempt to bring the U.S. Department of Energy's (DOE) carbon sequestration program activities into the "real world" by using a geographically-disposed-system type approach for the U.S. Each regional partnership is unique and covers a unique section of the U.S. and is tasked with determining how the research and development activities of DOE's carbon sequestration program can best be implemented in their region of the country. Although there is no universal agreement on the cause, it is generally understood that global warming is occurring, and many climate scientists believe that this is due, in part, to the buildup of carbon dioxide (CO(2)) in the atmosphere. This is evident from the finding presented in the National Academy of Science Report to the President on Climate Change which stated "Greenhouse gases are accumulating in Earth's atmosphere as a result of human activities, causing surface air temperatures and subsurface ocean temperatures to rise. Temperatures are, in fact, rising. The changes observed over the last several decades are likely mostly due to human activities, ...". In the United States, emissions of CO(2) originate mainly from the combustion of fossil fuels for energy production, transportation, and other industrial processes. Roughly one third of U.S. anthropogenic CO(2) emissions come from power plants. Reduction of CO(2) emissions through sequestration of carbon either in geologic formations or in terrestrial ecosystems can be part of the solution to the problem of global warming. However, a number of steps must be accomplished before sequestration can become a reality. Cost effective capture and separation technology must be developed, tested, and demonstrated; a database of potential sequestration sites must be established; and techniques must be developed to measure, monitor, and verify the sequestered CO(2). Geographical differences in fossil fuel use, the industries present, and potential sequestration sinks across the United States dictate the use of a regional approach to address the sequestration of CO(2). To accommodate these differences, the DOE has created a nationwide network of seven Regional Carbon Sequestration Partnerships (RCSP) to help determine and implement the carbon sequestration technologies, infrastructure, and regulations most appropriate to promote CO(2) sequestration in different regions of the nation. These partnerships currently represent 40 states, three Indian Nations, four Canadian Provinces, and over 200 organizations, including academic institutions, research institutions, coal companies, utilities, equipment manufacturers, forestry and agricultural representatives, state and local governments, non-governmental organizations, and national laboratories. These partnerships are dedicated to developing the necessary infrastructure and validating the carbon sequestration technologies that have emerged from DOE's core R&D and other programs to mitigate emissions of CO(2), a potent greenhouse gas. The partnerships provide a critical link to DOE's plans for FutureGen, a highly efficient and technologically sophisticated coal-fired power plant that will produce both hydrogen and electricity with near-zero emissions. Though limited to the situation in the U.S., the paper describes for the international scientific community the approach being taken by the U.S. to prepare for carbon sequestration, should that become necessary.

Air Pollution↗

Implementing chlamydia screening: what do women think? A systematic review of the literature.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis. METHODS: Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. ELIGIBILITY CRITERIA: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs. RESULTS: From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained. CONCLUSION: Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact.

Attitude to Health↗

Intelligent software for laboratory automation.

The automation of laboratory techniques has greatly increased the number of experiments that can be carried out in the chemical and biological sciences. Until recently, this automation has focused primarily on improving hardware. Here we argue that future advances will concentrate on intelligent software to integrate physical experimentation and results analysis with hypothesis formulation and experiment planning. To illustrate our thesis, we describe the 'Robot Scientist' - the first physically implemented example of such a closed loop system. In the Robot Scientist, experimentation is performed by a laboratory robot, hypotheses concerning the results are generated by machine learning and experiments are allocated and selected by a combination of techniques derived from artificial intelligence research. The performance of the Robot Scientist has been evaluated by a rediscovery task based on yeast functional genomics. The Robot Scientist is proof that the integration of programmable laboratory hardware and intelligent software can be used to develop increasingly automated laboratories.

Algorithms↗

The potential impact of the resource-based relative value scale on the practice of nuclear medicine.

The Resource-Based Relative Value Scale (RBRVS) is finally here. A system designed to equate physician work across the specialties, it has its own peculiar and unique problems. Modeling of the system was based on the single physician-patient interaction; it may not work properly for laboratory specialties. There are other unique considerations concerning how the model was constructed. Although data were collected specifically for nuclear medicine, they were not used in the final computations. There is disagreement over whether those data would benefit or hurt nuclear medicine reimbursement. As presently implemented, the RBRVS poses grave dangers for the future of nuclear medicine. These dangers come not only in the professional reimbursement section of the rules but in the technical component areas as well. Estimates for reduction of income by 1996 range as high as 55% for nuclear medicine. When one factors the implementation of the RBRVS by independent insurance carriers into the equation, the entire economic future becomes muddy. A brief historical review of the RBRVS, as well as discussion of potential future implications of this type of reimbursement system, is presented. Prognostication is at least as inexact a science as reimbursement. Hopefully, the author's outlook on the future of nuclear medicine is more pessimistic than it need be.

Cost Control↗

Control of exploitation-exploration meta-parameter in reinforcement learning.

In reinforcement learning (RL), the duality between exploitation and exploration has long been an important issue. This paper presents a new method that controls the balance between exploitation and exploration. Our learning scheme is based on model-based RL, in which the Bayes inference with forgetting effect estimates the state-transition probability of the environment. The balance parameter, which corresponds to the randomness in action selection, is controlled based on variation of action results and perception of environmental change. When applied to maze tasks, our method successfully obtains good controls by adapting to environmental changes. Recently, Usher et al. [Science 283 (1999) 549] has suggested that noradrenergic neurons in the locus coeruleus may control the exploitation-exploration balance in a real brain and that the balance may correspond to the level of animal's selective attention. According to this scenario, we also discuss a possible implementation in the brain.

Animals↗

A biologically motivated associative memory architecture.

A synthesis of analytical techniques from the fields of biology, mathematics, computer science and engineering are used to model the information processing characteristics of the mammalian cerebellar cortex. By viewing anatomically different neurons as representing network elements whose input-output functions are different, a mechanism for distributing information throughout the memory is proposed. The functional circuitry developed to implement this feature is called the microcircuit. Overlapping microcircuit activity is used to describe the memory's read and write operations. Key features of the memory model include: (1) its use of a sparse interconnection network, (2) its ability to manipulate very large input patterns, (3) its distributed storage of input data patterns and (4) its statistical reconstruction of stored patterns during memory read operations. Quantitative measures for the memory's recall fidelity and storage capacity are derived and results of computer simulations are presented.

Animals↗

Occurrence of dispensing errors and efforts to reduce medication errors at the Central Arkansas Veteran's Healthcare System.

BACKGROUND: Medical errors have received national attention in the past few years, largely due to the Institute of Medicine's (IOM) 1999 report, which found that over one million injuries and nearly 100,000 deaths occur annually in the US as a result of medical errors. PURPOSE: The purpose of this study was to examine the type and severity of dispensing errors reported by pharmacy services at the Central Arkansas Veteran's Healthcare System from October 1997 through September 2001 and to examine the efforts implemented by the Central Arkansas Veteran's Healthcare System to reduce overall medication-related errors. METHODS: Dispensing error reports for the Central Arkansas Veteran's Healthcare System were obtained for October 1997 to September 2001. Dispensing errors were tabulated in the Statistical Package for the Social Sciences (SPSS) according to the pharmacy section, type of error (wrong drug, wrong dose, wrong patient and 'other') and severity of error (minor, significant, major and unrated). Data were explored using descriptive statistics, chi2, independent sample t-tests and Pearson's correlation. Information on error reduction efforts was obtained from pharmacy administrative services. RESULTS: A total of 82 dispensing errors were reported from eight different pharmacy sections for the time period examined. Errors included 31 wrong drugs, 21 wrong doses, 24 wrong patients and six 'other' errors. The number of errors, according to severity, included 29 unrated, 30 minor, 21 significant and two major errors. Both major errors were due to wrong drug selection. In total, the highest number of errors occurred at the North Little Rock Ambulatory Care Pharmacy (39 errors) and the Little Rock Ambulatory Care Pharmacy (24 errors). Wrong drug and wrong dose dispensing errors were not significantly different among the pharmacy sections. Wrong patient selection was significantly different among pharmacy service sections. Wrong patient selection, wrong drug, and wrong dose were all significantly correlated with unrated severity, minor severity, and significant severity. Significant correlations were also found between wrong drug, wrong dose and wrong patient selection. There were no significant correlations between wrong patient selection and major severity, or other errors. chi2 analysis found significant differences in expected frequency among errors for wrong drug, wrong dosage, wrong patient and other errors. Significant differences were also found in expected frequencies between unrated, minor, significant and major errors. DISCUSSION: Although the major dispensing errors were not statistically different according to pharmacy services sections and not significantly correlated with any other categories, they both involved the selection of the wrong drug, which was also the most common error. In contrast, the selection of the wrong patient, the second most common error, was statistically different among pharmacy sections and was significantly correlated with all other dispensing type and severity of error except major severity and other errors. CONCLUSION: Focusing error reduction efforts on selection of the correct drug and correct patient would likely yield the best results in reducing dispensing errors since these errors combined accounted for 55 (67.1%) of the 82 reported errors.

Hospitals, Veterans↗

Description and evaluation of an acute stroke unit.

Clinical trials have demonstrated the superiority of coordinated interdisciplinary stroke unit care over conventional treatment of stroke patients on general medical wards. The evidence is so strong that several national bodies have recommended that stroke unit care be widely implemented. Translation of these research findings and care guidelines into clinical practice, however, represents a challenge for health care systems unaccustomed to managing stroke in a coordinated manner. This report describes the organization, operation and outcomes of the Acute Stroke Unit at the Queen Elizabeth II Health Sciences Centre in Halifax. By replicating and adapting the core characteristics identified in the randomized trials, we have been able to demonstrate the effectiveness of stroke unit care in a routine clinical setting. Our experience may help facilitate the development of organized stroke care in Canada.

Aged↗

[Scientific education of the candidate specialist in training].

Scientific education is an essential component of the post-graduate training. Fluency in the language of sciences is necessary to understand scientific progress and to translate new scientific advances at the level of medical practice. To reach this goal, specific research skills and participation in research projects should be introduced in postgraduate training. Lack of dedicated time and interest are major barriers in implementing systematically research in the curricula. Some suggestions are made in order to improve research training in the postgraduate programs.

Belgium↗

[Planned control of reproduction processes in industrialized pig production].

A planned process of concentration and specialisation in pig production has been introduced in the USSR, GDR, and other socialist countries in recent years and is likely to open up wider opportunities for the use of up-to-date technologies and latest findings of the biological sciences. Large-scale use of bio-engineering and methods of reproduction control is quite logical, in this context. This will provide a real chance for cyclogram control of all events important to management, planning, and follow-up of reproduction processes and for a planful implementation of industrialised production methods. Processes of cycle control are being increasingly applied to industrialised sow breeding units against the background of artificial insemination of pigs which is gaining widespread popularity after its emphasised introduction in the USSR. Research and field results regarding biological engineering in sow of oestrus, ovulation, pregnancy, and birth are reported in this paper and will, hopefully, help in determining mating and farrowing deadlines for breeding on the basis of artificial insemination and, consequently, contribute to widest possible programming of life cycles for the breeding animals concerned.

Animals↗

State of the science. Breastfeeding for mothers and low birth weight infants.

There is support in the research literature for encouraging mothers of preterm and LBW to breastfeed their infants, although the numerous barriers to their successful breastfeeding have been well documented. The emerging work addressing short- and long-term health benefits for preterm infants provide's scientific rationale for allocation of resources, that is, equipment and personnel, to assist these mothers in attaining their breastfeeding goals. The literature also has linked selected, individualized interventions to breastfeeding outcomes for this population. Examples of this linkage include milk expression recommendations for maximizing milk yield, techniques for in-hospital breastfeeding, and models for providing breastfeeding services in the NICU. Clinical priorities should focus on strategies for implementing the available research into practice and for using the research to establish standards of care for mothers who breastfeed preterm and LBW infants. Research priorities should focus on practice models for providing breastfeeding services that demonstrate improved breastfeeding outcomes and cost effectiveness for this vulnerable population.

Breast Feeding↗

Hand hygiene-beliefs or science?

Over a century has passed since Ignaz P. Semmelweis demonstrated the association between hand hygiene and nosocomial infections, but this simple procedure is still not recognized by many healthcare workers as one of the most important measures to prevent cross-transmission of microorganisms. A relatively large amount of research has been done, in particular to try to understand why compliance remains so low, in order to implement successful promotion campaigns. This research has generated a fair amount of strong scientific data which are sometimes misunderstood and misused because of myths or certain beliefs. Observational or intervention studies have consistently shown a number of risk factors associated with non-compliance, such as high workload, professional category, or type of ward. Others are thought to be barriers to adequate compliance but have not yet been properly assessed. These include skin irritation due to hand hygiene agents, lack of knowledge of hand hygiene recommendations, or lack of institutional policy. Future interventions to promote hand hygiene will need to address these risk factors, and target the individual healthcare worker, as well as the group or institution if a significant degree of success is to be achieved.

Attitude of Health Personnel↗

The Northwest Forest Plan: origins, components, implementation experience, and suggestions for change.

In the 1990s the federal forests in the Pacific Northwest underwent the largest shift in management focus since their creation, from providing a sustained yield of timber to conserving biodiversity, with an emphasis on endangered species. Triggered by a legal challenge to the federal protection strategy for the Northern Spotted Owl (Strix occidentalis caurina), this shift was facilitated by a sequence of science assessments that culminated in the development of the Northwest Forest Plan. The plan, adopted in 1994, called for an extensive system of late-successional and riparian reserves along with some timber harvest on the intervening lands under a set of controls and safeguards. It has proven more successful in stopping actions harmful to conservation of old-growth forests and aquatic systems than in achieving restoration goals and economic and social goals. We make three suggestions that will allow the plan to achieve its goals: (1) recognize that the Northwest Forest Plan has evolved into an integrative conservation strategy, (2) conserve old-growth trees and forests wherever they occur and (3) manage federal forests as dynamic ecosystems.

Conservation of Natural Resources↗

Evidence-based and population-based medicine: national implementation under the UME-21 project.

BACKGROUND AND OBJECTIVES: The Undergraduate Medical Education for the 21st Century (UME-21) project developed and implemented innovations to medical school curricula at medical schools across the country. This report describes the development and implementation of innovative approaches to improving instruction in evidence-based medicine with a population-based perspective. METHODS: Each school participating in the UME-21 project designed, implemented, and evaluated its own unique curriculum initiatives. We examined these initiatives using data abstracted from written reports submitted to the project Executive Committee. Additional data were obtained by personal communication with project directors and evaluators at the various schools, student and preceptor comments, internal program evaluation at each school, and external evaluation by the UME-21 project leadership. The Association of American Medical Colleges Graduation Questionnaire was also used. RESULTS: Fourteen of 18 participating schools implemented a broad range of curricula to facilitate teaching and learning about evidence-based and population-based medicine. Common themes included the application of evidence to patient care, use of clinical practice guidelines and pathways, and the general incorporation of evidence-based techniques (literature searching, critical appraisal, etc) into the teaching of other content, such as clinical science and managed care. Teaching approaches included Web-based and other computer-based education, an emphasis on active and self-directed learning, use of small groups and workshops, and distribution of this content over multiple years. As an alternative to full-length evidence-based medicine courses, many schools incorporated an evidence-based approach into existing courses and clerkships. Data demonstrated an upward trend in student satisfaction with how topics were presented at UME-21 schools. CONCLUSIONS: These innovations successfully demonstrated that evidence-based and population-based medicine content can be introduced into medical school curricula. Introducing these constructs in ways that demonstrate their relevance to patient care facilitates student learning.

Community Health Planning↗