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Reflection: a flawed strategy for the nursing profession.

The meaning and process of reflection and reflective practice appear to be currently accepted and institutionalized within the nursing profession. This paper, through use of a literature review, attempts to question the value that is consequently placed on this strategy and argues that on closer examination, reflection has no clear or universal definition, an uncertain framework for implementation, and is of unproven benefit to the professional practice of nurses. Given this evidence, the author concludes that reflection is a fundamentally flawed strategy that must be of limited benefit to the nursing profession.

Education, Nursing↗

A framework for integrated quality improvement.

The importance of maintaining and improving quality is well understood in most health care organizations. This work becomes more challenging as internal and external conditions rapidly change. A quality improvement framework was developed to help clinicians and administrators organize intergrated, multifaceted quality programs that have the flexibility necessary for success in today's fast-paced health care environment.

Case Management↗

Learning dermatology.

Students should be involved in curriculum planning and encouraged to formulate their own learning outcomes. Adult learners appreciate opportunities to learn from real or simulated experiences that are applicable to real-life situations. Contact with patients is essential to help students to develop empathy and communication skills and patients with chronic skin conditions such as psoriasis can make an active contribution to the education of students. Students learning dermatology use both pattern- recognition and analytical processes, but pattern recognition develops only with repetition and it is not realistic to expect students to acquire many diagnostic skills. Instead teachers should provide students with a framework that will enable them to analyse skin conditions, to understand the relevance of what is taught and to apply their learning in the future. All medical graduates should be able to describe the skin and record their findings each time they clerk a patient.

Clinical Competence↗

Framework for a clinical career structure in nursing.

There is an urgent need to define and clarify a clinical career structure in nursing. The development of a career structure is hindered by the proliferation of titles currently used by nurses when developing their knowledge and skills. It is proposed that the term nurse practitioner be replaced by either generalist or specialist nursing practitioner, depending on the individual's bias, and that nurses with a bias towards medicine be designated paramedical nurse practitioners. A three-band clinical career structure is suggested, based on these categories. This structure would allow nurses to develop their knowledge and competency while either remaining in a broader, generalist area or specializing in a particular field. This structure includes an advanced nursing practitioner level to accommodate those nurses with extensive experience of clinical nursing situations. It is imperative that the nursing profession decides its career pathways, otherwise they may find others doing it for them.

Career Mobility↗

Indicators for measuring the quality of family planning services in Nigeria.

This article presents the Situation Analysis approach as a means of collecting data that can be used to assess the quality of care provided by family planning service-delivery points (SDPs), and describes the quality of services offered in Nigeria. Elements of the quality of services provided at 181 clinical service-delivery points in six states of Nigeria are described. The substantive results from the study suggest that although most of the 181 service points sampled are functional, the quality of care being provided could be improved. Illustrative scores for these indicators and elements of the Bruce-Jain framework are given. By comparison with contraceptive prevalence surveys, the Situation Analysis approach is still in its early stages. Some methodological issues are raised here and future directions for strengthening the validity and applicability of the approach are discussed.

Bias↗

The ENB's implementation of the new strategy for research.

This article outlines the ENB's response to the Department of Health document Strategy for Research in Nursing, Midwifery and Health Visiting, published in May 1993, which sought to establish a framework to ensure that research in the nursing profession can make a full contribution to the delivery of high-quality care. The document declared itself to have two main objectives, which were to facilitate research and to enhance the research skills and experience of nurses.

Clinical Competence↗

Why American business demands twenty-first century skills: an industry perspective.

Public education is the key to individual and business prosperity. With a vested stake in education, educators, employers, parents, policymakers, and the public should question how this nation's public education system is faring. Knowing that recent international assessments have shown little or no gains in American students' achievement, the author asserts the clear need for change. As both a large American corporate employer and a provider of technology for schools, Dell is concerned with ensuring that youth will thrive in their adult lives. Changing workplace expectations lead to a new list of skills students will need to acquire before completing their schooling. Through technology, Dell supports schools in meeting educational goals, striving to supply students with the necessary skills, referred to as twenty-first century skills. The Partnership for 21st Century Skills, of which Dell is a member, has led an initiative to define what twenty-first century learning should entail. Through extensive research, the partnership has built a framework outlining twenty-first century skills: analytical thinking, communication, collaboration, global awareness, and technological and economic literacy. Dell and the partnership are working state by state to promote the integration of these skills into curricula, professional development for teachers, and classroom environments. The authors describe two current initiatives, one in Virginia, the other in Texas, which both use technology to help student learning. All stakeholders can take part in preparing young people to compete in the global economy. Educators and administrators, legislators, parents, and employers must play their role in helping students be ready for what the workforce and the world has in store for them.

Adolescent↗

Hidden dimensions of power and resistance in the translation process: a south African study.

This article examines the social relationships involved in the production of a Xhosa version of the Beck Depression Inventory (BDI). The South African sociopolitical context and the imperatives of the biomedical context are discussed. These play an important role in how the problem of semantic equivalence between translations, and the issue of the imposition of a colonialist, Western psychiatric framework are addressed. After a brief but critical outline of recommended translation techniques, the particular combination of back-translation and committee method employed in this study is presented. An analysis of the social relationships revealed a complex set of interrelated factors affecting the process. The power differential between researcher and back-translators, compounded by their different perceptions of the task, impeded discussion about the instrument. Translators had ostensibly markedly opposed claims to competence to speak for the "true Xhosa language". At a deeper level however, these claims, and indeed the entire translation enterprise, could be seen to be reproducing apartheid structures, regardless of the intention of the participants. The dynamics we describe are particularly salient in the South African context but may also be operative in other contexts.

Black or African American↗

Development of an innovative tool to assess hospital learning environments.

Nursing as a profession has evolved in response to societal needs for well-prepared practitioners who provide quality care to the needed in episodes of illness, and promote health among all age groups. Clinical practice enables the student to develop competencies in the application of knowledge, skills, and attitudes to clinical field situations. The clinical learning environment is a multidimensional entity with a complex social context. Previous research on clinical learning environment was examined, yet minimal studies have been conducted on hospital learning environments from the psychosocial educational perspective. With the mission to maximize nursing students' clinical learning experiences, the author developed and validated the Clinical Learning Environment Inventory (CLEI) based on the theoretical framework in psychosocial education. It is envisaged that this tool will assist the nurse professional to facilitate nursing students to achieve a productive clinical practice. This paper highlights the need and details the conceptual framework in the development of the CLEI. Although it is not presented as a research based paper, some statistical data are included to verify the reliability and validity of the newly-developed instrument.

Education, Nursing↗

Processing limitations in children with specific language impairment: the role of executive function.

Research suggests that children with specific language impairment (SLI) have processing limitations; however, the mechanisms involved have not been well defined or investigated in a theory-guided manner. The theory of constructive operators was used as a framework to explore processes underlying limited processing capacity in children with SLI. Mental attentional capacity, mental attentional interruption, and 2 specific executive functions (shifting and updating) were examined in 45 children with SLI and 45 children with normally developing language, aged 7 to 12 years. The results revealed overall group differences in performance on measures of mental attention, interruption, and updating, but not shifting. The findings supported the premise that mental attention predicted language competence, but that this relationship was mediated partially by updating.

Attention↗

Predicting physical activity intentions using a goal perspectives approach: a study of Hungarian youth.

Utilising a goal perspectives framework, a study predicting physical activity intentions in 12 to 16-year-old Hungarian adolescents was conducted with two samples. Theoretical predictions established a model that was tested through path analysis. Beliefs thought to underpin goal orientations were hypothesised to predict ego orientation (general and gift beliefs) and task orientation (learning and incremental beliefs). Task orientation was hypothesised to predict intentions directly, while ego orientation was hypothesised to predict intentions indirectly through perceived competence. Results from the first sample (n=301) suggested that the model could be improved by adding paths between general beliefs and perceived competence and between task orientation and perceived competence. This modified model was shown to fit data from a second sample (n=422) very well. Multi-group analysis confirmed a good fit and so the two samples were combined. The model fitted the data well for the total sample (n=723). Overall, results showed that 20.8% of the variance in intentions was explained by the model, and that sport ability beliefs were moderately associated with task orientation but only weakly associated with ego orientation. The motivational importance of a task orientation was confirmed with its direct prediction of intentions.

Achievement↗

Institutionalizing social support through the church and into the community.

The positive influence of social support on such health related outcomes as patient adherence to medical regimens and stress reduction at the worksite has captured the attention of public health researchers and practitioners alike. Yet, the broader social outcome of building community competency to undertake and sustain health related solutions without constant intervention from professionals still remains elusive. The difficulty may lie with the need to uncover on each occasion the various roles and functions of social support structures that may or may not exist in a given community. The intent would then be to graft an intervention onto these existing roles and functions in order to mirror the naturally occurring social support structures. A conceptual framework that has been used to institutionalize health related activities through the role and function of the black Church, as a social unit of identity and solution for rural black communities in North Carolina, is put forth for consideration.

Black or African American↗

Students' studying and approaches to learning in introductory biology.

This exploratory study was conducted in an introductory biology course to determine 1) how students used the large lecture environment to create their own learning tasks during studying and 2) whether meaningful learning resulted from the students' efforts. Academic task research from the K-12 education literature and student approaches to learning research from the postsecondary education literature provided the theoretical framework for the mixed methods study. The subject topic was cell division. Findings showed that students 1) valued lectures to develop what they believed to be their own understanding of the topic; 2) deliberately created and engaged in learning tasks for themselves only in preparation for the unit exam; 3) used course resources, cognitive operations, and study strategies that were compatible with surface and strategic, rather than deep, approaches to learning; 4) successfully demonstrated competence in answering familiar test questions aligned with their surface and strategic approaches to studying and learning; and 5) demonstrated limited meaningful understanding of the significance of cell division processes. Implications for introductory biology education are discussed.

Biology↗

Temperament and adolescent substance use: a transactional analysis of emerging self-control.

Presented is a conceptual framework linking the construct of temperament with environmental factors that covary with the onset and escalation of substance use. We propose that transactions between temperament characteristics of the child in family and peer contexts influence the development of self-control ability, a mediating factor for onset and possible transition to abuse in later adolescence. Risk-promoting dimensions may influence the emergence of self-control by amplifying relationship processes that detract from competence development. Emergence of good self-control can serve as a resilience factor and is linked with health-promoting cognitions. We also suggest that temperament and self-control moderate links between parenting, peer associations, and substance use. Implications of the transactional model for clinical intervention and research are discussed.

Adolescent↗

Benchmarks of fairness: a moral framework for assessing equity.

The health care systems of most advanced industrialized countries are currently undergoing extensive reforms. In Europe, in addition to economic and political issues, issues of "equity" and "solidarity" are very much on the minds of some health care reformers. Elsewhere in Europe, economics and politics dominate health care reform, and concerns about fairness are either absent or of secondary importance. Similarly, the recent health care debates in the United States were largely carried out in terms of payment schemes, cost-containment and outcome measures, campaign strategies, and political concessions. Issues of fairness were either hidden in the many features of the competing proposals and the debates about them, or totally ignored. In both cases, there has been no practical way to gauge how a given change would alter the equity or fairness of existing health care services. This article addresses that void by presenting ten scorable benchmarks of fairness.

Benchmarking↗

The spatio-temporal framework of melanogenic induction in pigmented retinal cells of Xenopus laevis.

Using methods involving transplantation of neuroectoderm and eye rudiments between ap/ap mutants and +/+ embryos of Xenopus laevis, new aspects of melanogenic induction have been ascertained. The possibility of separate induction of a melanocyte cell type and of the product of terminal differentiation in it-melanosomes, has been demonstrated. Melanogenic induction starts at the late gastrula stage. It has an irreversible character which has been shown using the technique of double transplantation. Melanogenic factor (MgF) is produced only by the region of endomesoderm which is adjacent to eye rudiments in the course of normal development. Competence for melanogenic induction lasts till stage NF 30. Melanogenic induction appears to be species-specific; at least after transplantation of eye vesicles from ap/ap Xenopus laevis to Rana temporaria the melanoprotein synthesis cannot be switched on. L-Tyrosine, under the conditions of the experiments, is not a factor in the induction of melanogenesis.

Ambystoma mexicanum↗

Medical students' attitudes towards breaking bad news: an empirical test of the World Health Organization model.

The literature regarding breaking bad news distinguishes three disclosure models: non-disclosure, full-disclosure and individualized disclosure. In this study, we investigated the relations between attitudes regarding disclosure of bad news and global professional attitudes regarding medical care in a sample of medical students (n=88). The Attitudes towards Breaking Bad News Questionnaire was developed and factor analysed to provide a valid and reliable instrument to measure attitudes regarding disclosure of bad news. The results indicate a preference for an individualized, patient-centred disclosure model in male and female students. Regarding the global professional attitudes, female students appear more humane-oriented than male students. Second, the relationship between global professional attitudes and attitudes regarding breaking bad news was examined by means of correlational and cluster analysis. The inter-relationship between global professional attitudes and attitudes regarding bad news is poor. Results of the cluster analysis, however, suggest that the sample can be divided into subsamples representing different disclosure clusters on the basis of specific combinations of global professional attitudes regarding medical care and attitudes regarding breaking bad news. The results are discussed in view of the theoretical framework proposed by the World Health Organization (WHO) in their training module on communication of bad news.

Attitude of Health Personnel↗

Identification of efficiently cleaved substrates for HIV-1 protease using a phage display library and use in inhibitor development.

The recognition sequences for substrate cleavage by aspartic protease of HIV-1 are diverse and cleavage specificities are controlled by complex interactions between at least six amino acids around the cleavage site. We have identified 45 efficiently cleaved peptide substrates of HIV-1 protease (PR) using substrate phage display, an approach that can elucidate both context-dependent and context-independent preferences at individual subsites of a protease substrate. Many of the selected peptides were cleaved more efficiently and had lower K(m) values than physiologically relevant substrates of HIV-1 PR. Therefore, mutations occurring in the cleavage sites of the Gag and Gag-pol polyproteins of HIV-1 could significantly lower the K(m) values to better compete against drugs for protease binding while maintaining cleavage rates necessary for viral replication. The most efficiently cleaved peptide substrate derived from these phage, Ac-GSGIF*LETSL-NH(2), was cleaved 60 times more efficiently and had a K(m) approximately 260 times lower than a nine-amino-acid peptide based on the natural reverse transcriptase/integrase cleavage site when assayed at pH 5.6, 0.2 M NaCl. The peptide substrates selected served as frameworks for synthesis of tight binding reduced amide inhibitors of HIV-1 PR. The results show that the most efficiently cleaved substrates serve as the best templates for synthesis of the tightest binding inhibitors. Thus, defining changes in substrate preferences for drug-resistant proteases may aid in the development of more efficacious inhibitors.

Amides↗