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PubMed2006

A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines.

Case-based teaching is regarded as a superior instructional method compared with lectures in promoting a learner's critical thinking skills. While much is known about the role a discussion facilitator plays in case-based teaching, the debate on the influence of the format and structure of cases on learning is controversial. We sought to identify strategies for constructing cases based on studies from multiple disciplines, which report the development and use of cases in teaching and learning. The purpose was to offer the medical and other educational communities a conceptual framework that can be examined in future research. Based on a review of 100 studies, we synthesised 17 strategies around 5 core attributes of cases: relevant (level of learner, goals and objectives, setting of case narrative); realistic (authenticity, distractors, gradual disclosure of content); engaging (rich content, multiple perspectives, branching of content); challenging (difficulty, unusual cases, case structure, multiple cases), and instructional (build upon prior knowledge, assessment, feedback, and teaching aids). Despite the wide use of cases in disparate disciplines, there has been no overarching study that synthesises strategies of case development or tests these strategies in research settings. The framework we developed can serve as a menu of case development options that educators and researchers can pilot and evaluate in their local settings.

Clinical Competence↗
PubMed2004

Witnessing the effects of political violence in families: mechanisms of intergenerational transmission and clinical interventions.

In this era of globalization, when news about political violence can haunt anyone, anywhere, those whose families have suffered political violence in the past are particularly vulnerable to current distress. Skilled in understanding transgenerational processes, family therapists need to be familiar with the mechanisms by which children are exposed to the effects of political violence suffered by their elders-that is, the ways in which they become their witnesses. This article presents a framework for understanding how the trauma of political violence experienced in one generation can "pass" to another that did not directly experience it, and proposes a model to guide clinical intervention.

Adult↗
PubMed2000

A conceptual model for the development of professional behaviours in occupational therapists.

The ever-changing, dynamic practice environment coupled with increased consumer needs and awareness create an atmosphere that requires optimal professionalism from occupational therapists. Professionalism requires specific knowledge, attitudes, and values--all manifested by professional behaviours. The authors assume that professional behaviours mature through a natural developmental process; a process that requires careful nurturing on the part of educators and clinical supervisors. Based on this assumption, the authors propose this conceptual model based on Erikson's life cycle stages. The model implies that occupational therapy professional behaviours develop sequentially through stages that begin during the educational process of occupational therapists, and progress throughout their career. The purpose of this model is to provide a framework for educators and supervisors to nurture professional behaviours in students and novice clinicians, and to continue their own professional growth.

Career Mobility↗
PubMed1995

Standardized care plan. Managing Alzheimer's patients at home.

1. Family-provided care of members with Alzheimer's disease and related disorders (ADRD) is complicated by the presence of secondary behavioral symptoms, such as agitation, that lead to caregiver depression, burden, and breakdown. 2. Caregiver education to manage secondary symptoms in ADRD can be simplified by using a theoretical framework of person-environment fit, providing a selection of interventions to modify the environment to reduce demand on the dwindling resources of the demented person. 3. The Progressively Lowered Stress Threshold (PLST) model identifies six areas of stress for persons with ADRD fatigue, change of caregiver, environment or routine, demands to achieve beyond capability, multiple and competing stimuli, affective response to perceived losses, and physical stressors.

Aged↗
PubMed1999

Nurses, patients benefit from evaluation process.

The privileging process at St. Marys Hospital Medical Center in Madison, WI, provides a framework for professional growth of nurses. Key areas for professional development outlined in the process include intellectual, technical, interpersonal, and ethical. Specific functions and responsibilities are delineated in charts the nurses use to track their progress.

Benchmarking↗
PubMedDate not supplied

Classifying medical devices according to their maintenance sensitivity: a practical, risk-based approach to PM program management.

Many medical equipment items need periodic attention to ensure that they continue to operate properly and safely; and most inspecting agencies require healthcare facilities to have a competent equipment maintenance program that is focused on the most critical of those devices. There is however a long-standing lack of consensus on how best to determine which devices should be included in this critical device category, and which can reasonably be excluded. A new methodology is proposed for establishing a logical, fact-based framework for determining which devices should be included. It is based in part on a new FDA-sanctioned definition of what an appropriate regimen of planned maintenance activities for a medical device should include. This new definition addresses the medical device users' concerns about periodic performance verification and safety testing as well as detecting and correcting the wear or progressive deterioration of any non-durable parts, which is the primary focus of the conventional preventive maintenance programs found in less critical industries. The analytical approach proposed utilizes technical information that is either already available or which can be easily developed. It characterizes each different device by means of a 3-letter maintenance sensitivity profile that can be used to analyze the effectiveness of the maintenance procedures as well as quantify the device's sensitivity to planned maintenance. A collaborative effort to assemble and organize this data would provide the industry with a sound, logical platform for narrowing the scope of most PM programs and allow us to redirect a significant amount of scarce technical manpower into more productive activities such as device user training.

Equipment and Supplies↗
PubMed2005

The impact of corporate memory loss: What happens when a senior executive leaves?

PURPOSE: The author is a nursing management practitioner, whose purpose in writing this paper is twofold: to examine the impact of corporate memory loss on a health care institution, caused by increasing retirement rates of senior executives; and to use this research as an opportunity for action learning where both the author and the institution can benefit from the learning outcomes. DESIGN/METHODOLOGY/APPROACH: Using qualitative research methods based on ethnographic interviewing techniques and grounded theory, the author interviews 12 senior executives from four diverse health care facilities. The purpose is to determine the point at which corporate memory loss, in the form of tacit knowledge in the heads of departing executives, becomes a problem for the institution. FINDINGS: The research determined that the requisite managerial competencies normally assumed for senior management positions are insufficient to minimize the negative impacts of corporate memory loss caused by departing senior executives. Effective knowledge management and knowledge transfer within the organization are fundamental for ongoing organizational effectiveness. RESEARCH LIMITATIONS/IMPLICATIONS: The research is limited to 12 senior executives. The grounded theory nature of the research provides a framework for more research in other institutions to test and further explore some of the findings. PRACTICAL IMPLICATIONS: One of the most significant threats facing the majority of health care organizations related to the aging workforce is the greater number of staff who are retiring from all levels within the organization. The development of techniques to reducing the impact of corporate memory loss on the culture of an organization will increase its effectiveness, help build continuity, and provide a more secure footing for the workforce of the future. ORIGINALITY/VALUE: The exit of knowledge workers is causing a major problem for Canada's health care organizations. This study throws more light on to this problem from the point of view of senior executives who have been specifically impacted by the problem of corporate memory loss.

Canada↗
PubMed1995

Redefining nursing according to patients' and families' needs: an evolving concept. AACN Certification Corporation.

Patients' and families' needs have been displaced from the core of today's health-care system. Nurses are positioned to serve a pivotal role during such a critical time, as health-care systems evolve. The health-care system of the future must be driven by the needs of patients and families. Nurses must make decisions and take actions that are crucial in ensuring that this becomes a reality. Nurses must acknowledge that the historical conceptualization of nursing--delineating clinical practice dimensions according to a patient's diagnosis, a nurse's role, the clinical setting, and the patient's psychosocial and physiologic systems--is of limited value if we are to meet these future challenges. Redefining nursing practice according to patients' needs provides an organizing framework to examine, across all levels of nursing, the dimensions of practice most likely to meet patient needs and contribute to optimal outcomes, as well as enhance the linkages between practice, education, and research.

Clinical Competence↗
PubMed1998

Peer review. Strengthening leadership skills.

In this model, peer review takes place on a nursing department-wide basis within the framework of a preceptor and clinical ladder program. The peer review program is described step-by-step, from planning through evaluation.

Humans↗
PubMed2003

Cell-fate specification in the epidermis: a common patterning mechanism in the root and shoot.

The specification of epidermal hairs in Arabidopsis provides a useful model for the study of pattern formation in plants. Although the distributions of hair cells in the root and shoot appear quite different, recent studies show that pattern formation in each relies on a common cassette of transcriptional regulators. During development in each organ, neighboring cells compete to express regulators that specify the primary cell fate (including WEREWOLF [WER]/GLABRA1 [GL1], GL3/bHLH, TRANSPARENT TESTA GLABRA [TTG], and GL2), as well as those that prevent their neighbors from adopting this fate (including CAPRICE [CPC] and TRIPTYCHON [TRY]). The basic mechanism of lateral inhibition with feedback that has been uncovered by recent studies provides a conceptual framework for understanding how patterns of cell fate in general may be specified during plant development.

Arabidopsis↗
PubMed1999

Metabolic engineering from a cybernetic perspective. 1. Theoretical preliminaries

The theoretical basis of a cybernetic metabolic network design and analysis framework, which has been subsequently successfully applied to predict system response to genetic alteration, is presented. This conceptual methodology consists of three main branches, namely, a model realization framework, a representation of genetic alteration, and lastly, a metabolic design component. These concepts are introduced as a series of postulates that describe the basic tenets of the approach. Each branch is discussed in turn, starting with the cybernetic representation of arbitrarily complex metabolic networks. A set of postulates is put forth that affords the modular construction of cybernetic models of metabolic networks using as a base a library of elementary pathways. This is followed by a discussion of the representation of genetic alterations within the cybernetic framework. It is postulated that the objective of the base network and the altered system are identical (at least on the time scale required for the organism to "learn" new objectives). This implies, with respect to resource allocation, that the base network and its genetically altered counterpart may still be treated as optimal systems; however, the set of competing physiological choices open to the altered network expands or contracts depending upon the nature of the genetic perturbation. Lastly, to add a predictive design aspect to the methodology, we present a set of postulates that outline the application of metabolic control analysis to cybernetic model systems. We postulate that sensitivity coefficients computed from a cybernetic model, although still local in scope, have the added benefit of a systematic representation of regulatory function as described by the cybernetic variables. Thus, information gained from sensitivity measurements stemming from a cybernetic model include the explicit input of metabolic regulation, a component that is lacking in a purely kinetic representation of metabolic function. The sensitivity results can then be employed to develop qualitative strategies for the rational alteration of metabolic function, which can be evaluated by simulation of an appropriately modified cybernetic model of the base network.

Journal Article↗
PubMed2004

Coexistence of cycling and dispersing consumer species: Armstrong and McGehee in space.

Two competing consumer species may coexist using a single homogeneous resource when the more efficient consumer--the one having the lowest equilibrium resource density--has a more nonlinear functional response that generates consumer-resource cycles. We extend this model of nonequilibrium coexistence, as proposed by Armstrong and McGehee, by putting the interaction into a spatial context using two frameworks: a spatially explicit individual-based model and a spatially implicit metapopulation model. We find that Armstrong and McGehee's mechanism of coexistence can operate in a spatial context. However, individual-based simulations suggest that decreased dispersal restricts coexistence in most cases, whereas differential equation models of metapopulations suggest that a low rate of dispersal between subpopulations often increases the coexistence region. This difference arises in part because of two potentially opposing effects on coexistence due to the asynchrony in the temporal dynamics at different locations. Asynchrony implies that the less efficient species is more likely to be favored in some spatial locations at any given time, which broadens the conditions for coexistence. On the other hand, asynchrony and dispersal can also reduce the amplitude of local population cycles, which restricts coexistence. The relative influence of these two effects depends on details of the population dynamics and the representation of space. Our results also demonstrate that coexistence via the Armstrong-McGehee mechanism can occur even when there is little variation in the global densities of either the consumers or the resource, suggesting that empirical studies of the mechanisms should measure densities on several spatial scales.

Animal Migration↗
PubMed1997

Assessment of severity and prognosis in acute pancreatitis.

Assessment of severity and prognosis in acute pancreatitis was originally driven by clinicians' needs for the prediction of outcome, together with the requirement of researchers for objective measurement of severity. Evaluation of the multitude of competing systems has been hindered by varying definitions of severity, incomplete reporting and a lack of comparative data. Although clinical assessment, Ranson and Glasgow scores remain predominant, the recent literature reflects how needs have changed, as a result of improved understanding of the biological events underlying attacks and technological advances. The Atlanta International Symposium should provide a suitable framework for progress.

Acute Disease↗
PubMedDate not supplied

Ms B and legal competence: examining the role of nurses in difficult ethico-legal decision-making.

The case of Ms B throws up some interesting issues regarding the role of the nurse in assisting patients in making and implementing their decisions. The High Court transcript makes it clear who the voices with influence in legal matters were, and why the decisions they took were made. Absent from the myriad voices is that of the profession of nursing. Are nurses silenced by professional boundaries, the legal framework or lack of confidence? The concept of nursing advocacy is once again thrown into relief and critical questions need asking about the limits of professional nursing practice.

Adult↗
PubMed2003

Testing a molecular clock without an outgroup: derivations of induced priors on branch-length restrictions in a Bayesian framework.

We propose a Bayesian method for testing molecular clock hypotheses for use with aligned sequence data from multiple taxa. Our method utilizes a nonreversible nucleotide substitution model to avoid the necessity of specifying either a known tree relating the taxa or an outgroup for rooting the tree. We employ reversible jump Markov chain Monte Carlo to sample from the posterior distribution of the phylogenetic model parameters and conduct hypothesis testing using Bayes factors, the ratio of the posterior to prior odds of competing models. Here, the Bayes factors reflect the relative support of the sequence data for equal rates of evolutionary change between taxa versus unequal rates, averaged over all possible phylogenetic parameters, including the tree and root position. As the molecular clock model is a restriction of the more general unequal rates model, we use the Savage-Dickey ratio to estimate the Bayes factors. The Savage-Dickey ratio provides a convenient approach to calculating Bayes factors in favor of sharp hypotheses. Critical to calculating the Savage-Dickey ratio is a determination of the prior induced on the modeling restrictions. We demonstrate our method on a well-studied mtDNA sequence data set consisting of nine primates. We find strong support against a global molecular clock, but do find support for a local clock among the anthropoids. We provide mathematical derivations of the induced priors on branch length restrictions assuming equally likely trees. These derivations also have more general applicability to the examination of prior assumptions in Bayesian phylogenetics.

Animals↗
PubMed1997

Mapping the difficulties experienced by clinicians and managers in health and social care who are seeking to develop research skills.

In 1994 the Department of Health commissioned project work and reviews to inform the development of a National Strategy to enhance the capacity of the NHS workforce to contribute to Research and Development. This paper reports one aspect of this review: a preliminary study mapping the difficulties experienced by clinicians and managers who sought to develop their research skills. A range of professionals were included in the sample, all of whom had applied for funding to undertake research education or training through a variety of schemes offering differing levels of support. There was a remarkable degree of consistency between the professional groups in terms of their level of training, success in achieving funding and their perception of the difficulties they faced in pursuing funding for research training--which they ranked in the same order of importance. However, two major significant differences arose: nurses and therapists rated their managers as less helpful, and they felt that completing application forms for research training was a skill that they lacked. The ranking of areas of difficulty, and the additional comments made by all respondents highlight issues that need to be addressed within a coherent strategic framework to reduce the difficulties experienced by those professionals wishing to pursue funding for research training.

Adaptation, Psychological↗
PubMed2002

Trust in leadership: meta-analytic findings and implications for research and practice.

In this study, the authors examined the findings and implications of the research on trust in leadership that has been conducted during the past 4 decades. First, the study provides estimates of the primary relationships between trust in leadership and key outcomes, antecedents, and correlates (k = 106). Second, the study explores how specifying the construct with alternative leadership referents (direct leaders vs. organizational leadership) and definitions (types of trust) results in systematically different relationships between trust in leadership and outcomes and antecedents. Direct leaders (e.g., supervisors) appear to be a particularly important referent of trust. Last, a theoretical framework is offered to provide parsimony to the expansive literature and to clarify the different perspectives on the construct of trust in leadership and its operation.

Humans↗