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PubMedDate not supplied

Education for the advanced practice of clinical nurse specialists.

The results of an ethnographic study of the expert practice of clinical nurse specialists (CNSs) can be used to develop a curriculum based on the actual clinical competencies and skilled performance of successful CNSs. Benner's seven domains of expert clinical nurse practice formed the conceptual framework for an investigation that confirmed that expert CNSs demonstrate those domains as well as additional clinical, educational, and consultative competencies specific to the role. Several examples from the practice of oncology CNSs are included. Incorporating these findings into graduate education learning experiences would ensure that new graduates of CNS programs have a grasp of the realistic as well as the theoretical aspects of the role.

Clinical Competence↗
PubMed1998

Valuation of Ecological Resources and Functions

/ Ecological resources are natural resources that provide certain necessary but overlooked system maintenance functions within ecosystems. Environmental economics is in search of an appropriate analysis framework to determine economic values of such resources. This paper presents a framework that estimates and compiles the components of value for a natural ecosystem. The framework begins with the ecological processes involved, which provide functions within the ecosystem and services valued by humans. We discuss the additive or competive nature of these values, and estimate these values through conventional and unconventional techniques. We apply the framework to ecological resources in a shrub-steppe dryland habitat being displaced by development. We first determine which functions and services are mutually exclusive (e.g., farming vs soil stabilization) and which are complementary or products of joint production (e.g., soil stabilization and maintenance of species). We then apply benefit transfer principles with contingent valuation methodology (CVM), travel cost methodology (TCM), and hedonic damage pricing (HDP). Finally, we derive upper-limit values for more difficult-to-value functions through the use of human analogs, which we argue are the most appropriate method of valuation under some circumstances. The highest values of natural shrub-steppe habitat appear to be derived from soil stabilization.KEY WORDS: Natural resource economics; Ecological economics; Ecological resources; Shrub-steppe; Environmental valuation; Cost; Benefit; Value

Journal Article↗
PubMed1994

Practical knowledge and competencies of the healing role of the nurse practitioner.

This qualitative study describes the practical knowledge and competencies of the healing role of the nurse practitioner. The conceptual framework is based on Benner's (1984) domains of nursing practice and aspects of practical knowledge and Brykczynski's (1985) study of the clinical practice of nurse practitioners. The healing role is described within the context of the healing domain of the National Organization of Nurse Practitioner Faculties' curriculum guidelines (Zimmer et al., 1990) and Benner's aspects of practical knowledge. The study used the interpretive research approach of Heideggerian hermeneutic phenomenology. The findings contribute two maxims that constitute aspects of practical knowledge: "little things mean a lot" and "healing begins with listening," and two additional healing competencies: sensitive humor and risk taking.

Clinical Competence↗
PubMed1996

Assessment of clinical and communication skills: operationalizing Benner's model.

The introduction of ward-based clinical assessment of nursing skills in the 1970s meant a more realistic method of assessment, but still essentially a 'snapshot' of the student's practical abilities. This now being replaced by continuous clinical assessment which requires that student nurses meet the expected level of competence in a range of nursing skills in each clinical placement. Benner's (1984) model of skill acquisition is currently receiving considerable attention by nurse educationalists and is providing the framework for many curricula (English 1993). The model identifies five stages of development in nursing: novice; advanced beginner; competent; proficient; and expert. What is needed, however, is a more detailed description of what those stages mean in terms of the component parts of nursing, especially the clinical and communication skills. This paper describes a framework for the assessment of clinical and communication skills, a framework which seeks to operationalize Benner's model by defining the level of performance expected in clinical and communication skills at each stage.

Clinical Competence↗
PubMed1996

Statistical methods for cost-effectiveness analyses.

A statistical framework is presented for examining cost and effect data on competing interventions obtained from an RCT or from an observational study. Parameters of the join distribution of costs and effects or a regression function linking costs and effects are used to define cost-effectiveness (c-e) measures. Several new c-e measures are proposed that utilize the linkage between costs and effects on the patient level. These measures reflect perspectives that are different from those of the commonly used measures, such as the ratio of expected cost to expected effect, and they can lead to different relative rankings of the interventions. The cost-effectiveness of interventions are assessed statistically in a two stage procedure that first eliminates clearly inferior interventions. Members of the remaining admissible set are then rank ordered according to a c-e preference measure. Statistical techniques, particularly in the multivariate normal case, are given for several commonly used c-e measures. These techniques provide methods for obtaining confidence intervals, for testing the hypothesis of admissibility and for the equality of interventions, and for ranking interventions. The ideas are illustrated for a hypothetical clinical trial of antipsychotic agents for community-based persons with mental illness.

Antipsychotic Agents↗
PubMed1996

Home hemodialysis--yes, it can be learned.

Sacred Heart Kidney Center has maintained a strong home hemodialysis program in Spokane for the past 34 years. Patients who choose this option consistently lead more independent lives, taking more responsibility for their own care. They have the positive attitude that dialysis is a small part of their lives rather than the core of a life dominated by a schedule at a dialysis center. Sacred Heart's home hemodialysis program fosters independence and self-motivation using a stepwise training process for the patient and partner. A skilled training nurse directs the training at the dialysis center. The nurse's work is enhanced by the entire dialysis team, including the nephrologist, social worker, dietitian, and equipment technician. The patient and partner pass through a series of integrated learning blocks, mastering each at their own pace. This method is an effective and efficient way of leading the patient and partner to competence and independence. Training and follow-up provide the framework for supporting day-to-day dialysis in the patient's home and allow for continued multidisciplinary interventions.

Hemodialysis, Home↗
PubMed1995

Security of attachment in 8-12-year-olds: a revised version of the Separation Anxiety Test, its psychometric properties and clinical interpretation.

This study examined the reliability and validity of an adapted version of the Separation Anxiety Test (SAT) for 8-12-year-old children. Clinical (N = 21) and nonclinical (N = 21) participants were compared on responses to the SAT coded using the Seattle scoring indices. Inter-rater reliability was established at an acceptable level, however, test-retest reliability and internal test construction were less satisfactory. Sample comparisons found the clinical participants described themselves as less securely attached and more avoidant of emotional expression than the control participants. The indices of attachment security were also related to various socioemotional aspects of functioning. In addition, the results indicated that describing "self" as different from a similar "other" child was significantly related to parental reports of poor social competence. Results are discussed in relation to an Attachment Theory framework as well as from a clinical perspective.

Anxiety, Separation↗
PubMed1992

Independent studies program in the basic sciences. A curricular innovation.

The Independent Studies Program was initiated at the New York College of Podiatric Medicine during the early months of 1987, and it has achieved continued success and acceptance from the administration, faculty, and students. The program emphasizes competence as the constant within a relatively time-independent framework. This paper presents, in a longitudinal fashion, the Independent Studies Program as a program model that combines criterion-referencing concepts, mastery-based learning combinations, and self-learning strategies. As a result, students have taken the initiative for diagnosing their learning needs, formulating their learning goals, identifying their human and material resources, and evaluating their learning outcomes.

Curriculum↗
PubMedDate not supplied

[Psychosocial guidance of nursing home personnel by group therapy. Basic considerations and initial experience].

Support groups for those professional caregivers who work in homes for the aged are seldom. Focussing on occupational stressors in this profession and the burnout research as a conceptual framework, a support group is introduced. To sustain the social competence and the coping skills of the caregivers are the basic aims of this group. Based on role taking and psychodrama as intervention techniques, outcomes from this group are discussed. Recommendations for future groups as a support system for caregivers in homes for the aged are derived.

Adaptation, Psychological↗
PubMed2026

Spindle Assembly Checkpoint Competency Determines Sensitivity to KIF18A Inhibition in Small-Cell Lung Cancer.

BACKGROUND: Small-cell lung cancer (SCLC) is characterized by pervasive chromosomal instability (CIN) and remains largely refractory to targeted therapies. KIF18A, a motor protein that regulates chromosome alignment during mitosis, has emerged as a selective dependency in CIN-high tumors. Whether this dependency extends to SCLC, a prototypical CIN-high cancer, has not been established, and biomarkers predicting response to KIF18A inhibition, currently in clinical trials, are lacking. METHODS: We integrated analyses of patient tumor datasets, neuroendocrine (NE) and non- NE SCLC cell lines, and functional perturbation models to define the determinants of response to KIF18A inhibition. Chromosomal instability metrics, transcriptional programs, mitotic dynamics, and spindle assembly checkpoint (SAC) function were assessed using genomic profiling, live-cell imaging, genetic perturbation, and pharmacologic inhibition. RESULTS: KIF18A expression was elevated in SCLC tumors and correlated with CIN-associated transcriptional programs, proliferative markers, and NE status; however, these features did not predict sensitivity to KIF18A inhibition. Instead, response was determined by the functional integrity of the SAC. SAC-proficient SCLC cells underwent sustained mitotic arrest followed by apoptotic cell death upon KIF18A inhibition, whereas SAC-defective cells failed to maintain checkpoint activation and survived. Mechanistically, resistant cells exhibited impaired kinetochore recruitment of core SAC components, including MAD1 and BUBR1. Importantly, transient induction of acute CIN through MPS1 inhibition partially restored sensitivity to KIF18A inhibition in resistant models. CONCLUSIONS: This study provides the first mechanistic characterization of KIF18A dependency in SCLC, identifying SAC competency as the primary determinant of response. These findings establish a biologically informed framework for patient stratification and rational combination strategies. TRANSLATIONAL RELEVANCE: Small-cell lung cancer (SCLC) is an aggressive malignancy with few effective targeted therapies and marked chromosomal instability. KIF18A has emerged as a potential therapeutic target in genomically unstable cancers, but biomarkers predicting response to KIF18A inhibition are lacking. We demonstrate that sensitivity to KIF18A inhibition in SCLC is determined not by KIF18A expression, neuroendocrine subtype, or baseline chromosomal instability, but by the functional integrity of the spindle assembly checkpoint (SAC). SCLC cells with intact SAC signaling undergo sustained mitotic arrest and apoptosis upon KIF18A inhibition, whereas SAC-defective cells bypass checkpoint activation and survive aberrant mitosis. Notably, transient induction of acute chromosomal instability through MPS1 inhibition partially restores sensitivity in resistant models. Together, these findings identify mitotic checkpoint competency as a mechanistic determinant and candidate predictive biomarker for KIF18A-targeted therapies, providing a biologically informed framework for patient stratification and rational combination strategies relevant to ongoing KIF18A inhibitor clinical trials.

Journal Article↗
PubMed1995

A new conotoxin affecting sodium current inactivation interacts with the delta-conotoxin receptor site.

We describe a new peptide conotoxin affecting sodium current inactivation, that competes on binding with delta-conotoxin TxVIA (delta TxVIA). The amino acid sequence of the new toxin, designated conotoxin NgVIA (NgVIA), is SKCFSOGTFCGIKOGLCCSVRCFSLFCISFE (where O is trans-4-hydroxyproline). The primary structure of NgVIA has an identical cysteine framework and similar hydrophobicity as delta TxVIA but differs in its net charge. NgVIA competes with delta TxVIA on binding to rat brain synaptosomes and molluscan central nervous system and strongly inhibits sodium current inactivation in snail neurons, as does delta TxVIA. In contrast to delta TxVIA, NgVIA is a potent paralytic toxin in vertebrate systems, its binding appears to be voltage-dependent, and it synergically increases veratridine-induced sodium influx to rat brain synaptosomes. delta TxVIA acts as a partial antagonist to NgVIA in rat brain in vivo. NgVIA appears to act via a receptor site distinct from that of delta TxVIA but similar to that of Conus striatus toxin. This new toxin provides a lead for structure-function relationship studies in the delta-conotoxins and will enable analysis of the functional significance of this complex of receptor sites in gating mechanisms of sodium channels.

Amino Acid Sequence↗
PubMed2026

Advancing nursing education through social and emotional learning: A systematic review guided by the Collaborative for Academic, Social, and Emotional Learning framework.

BACKGROUND: With Generation Z entering the nursing workforce in growing numbers, strengthening social and emotional learning is critical for academic success, professional adaptation, and safe practice. However, the existing evidence remains fragmented because of varied interventions and inconsistent approaches. OBJECTIVES: This systematic review examined (1) the social and emotional learning essential for nursing students and nurses within the Collaborative for Academic, Social, and Emotional Learning framework, (2) their impact on educational and clinical outcomes, and (3) implications for advancing nursing education and practice. METHODS: Following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five international (PubMed, EMBASE, CINAHL, PsycINFO, Cochrane) and three Korean (RISS, KoreaMed, KMBASE) databases were searched up to June 2025. Eighteen studies involving 2,952 participants met the inclusion criteria, including quasi-experimental quantitative studies, descriptive quantitative studies, qualitative studies, and mixed-methods studies. The methodological quality of the included studies was appraised using the Mixed Methods Appraisal Tool. RESULTS: Within the Collaborative for Academic, Social, and Emotional Learning framework, relationship skills and self-management were the most frequently studied competencies, emphasizing teamwork, communication, and stress regulation. Self-awareness and social awareness were underexplored, despite their importance in empathy, resilience, and reflective practice. Responsible decision-making was the least studied competency, despite its importance in ethical reasoning. Social and emotional learning was consistently associated with enhanced adaptation, communication, leadership, relationships, and clinical performance. Effective strategies included blended learning, simulation, reflective activities, and mentorship, which are aligned with Generation Z's learning preferences. CONCLUSION: Although social and emotional learning integration is associated with improvements in educational and clinical outcomes in nursing, current research has largely centered on relational and stress-related competencies while underrepresenting responsible decision-making. To cultivate reflective, empathetic, and ethically grounded nurses, curricula should integrate social and emotional learning through a balanced and structured approach. REGISTRATION: This study was registered on PROSPERO (ID: CRD420251005683).

Humans↗
PubMed1997

Feminism: a path to clinical knowledge development.

Nurses are under increasing pressure to defend the efficacy, value and cost benefits of professional nursing care. Now more than ever, there is a need for nurses to undertake quality clinical research, through which practice may be shaped and guided. Feminist theory can provide a lens through which nurses may explore clinical issues. It also provides a framework by which socially constructed differences, such as gender and culture, may be incorporated into the design of clinical research projects. Because feminism is an openly political and transformative process, feminist concepts are suitable for use where the aim of the research is to catalyse practice change. This paper explores the use of feminism as a theoretical framework for nursing research.

Clinical Competence↗
PubMed1981

Hemispheres as independent resource systems: limited-capacity processing and cerebral specialization.

In this article, we develop as framework for understanding how cerebral specialization of function contributes to the flexibility of human information processing. We propose that the left and right hemispheres together form a system of two mutually inaccessible and finite pools of resources. Further, we propose that these two types of resources cannot be made available in different amounts at any given time. This framework is essentially a special case of a multiple-resources model of limited-capacity information processing. It accounts for a broad range of data from experiments involving perceptual and cognitive information processing, control of motor performance, and changes in electrical activity of the brain. It also provides insights into why the cerebral specialization literature has been plagued with problems that have made theorizing so difficult. In addition, the theory provides insights into mechanisms that might be responsible for patterns of task interference that are not easily handled by an information-processing model in which processes compete for supplies from a single pool of undifferentiated resources. Thus, the framework we are proposing has important theoretical and methodological implications for researchers in both divided attention and cerebral specialization.

Attention↗
PubMed1979

Voluntary dental laboratory certification program. Council on Prosthetic Services and Dental Laboratory Relations.

Laboratory certification does not offer concrete guarantees of consistent high quality of products or services. It does, however, identify, for the dental profession, a competency and acceptability factor on which to base a predication of performance by the laboratory. Also, laboratory certification establishes a framework within which the dental laboratory industry can work to continue upgrading its facilities and personnel, demonstrates the concern of certified laboratories for continuing competence, and indicates to government and third-party payers a willingness to develop standards endorsed by the industry.

Certification↗
PubMed1990

Critical features of a curriculum in health care quality and resource management.

In response to mounting demands for quality and accountability in health care, a science of health care quality and resource management (QRM) has evolved, but too slowly and without the academic base needed to prepare practitioners to assume new roles and fulfill requirements to regulate their practice. To develop such a base, The University of Houston and The University of Texas Health Science Center sponsored a needs assessment survey to identify areas of knowledge and skills to be included in a master's degree curriculum in QRM. The study used a three-cycle Focus Delphi technique to secure experts' refinement of the survey instrument and consensus among participants, who included practitioner-members of the National Association of Quality Assurance Professionals (NAQAP), of health care administration educational program directors, and hospital administrators. Starting with a listing based on a competency outline obtained from NAQAP, the study identified critical learning needs and elaborated a framework with 12 broad categories and 108 specific knowledge and skill areas.

Curriculum↗