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PubMed2000

The grid that bridges the gap.

Since the introduction of the Diploma in Higher Education in Nursing Studies (Dip HE NS) at this Faculty, course evaluations have consistently reported students' fears and apprehensions which result from their perceived lack of practical ability. Their experiences are supported by accounts from other nursing faculty (Elkan et al. 1993, Jowett & Walton 1994). In 1994, following analysis of course evaluations and a review of the literature on skill acquisition, experiential skills teaching was resumed within the faculty setting. This was after a period in the late 1980s when the cultural thinking was that 'practice suites' were to be frowned upon, and that skills were best taught in practice placements. Despite rigorous literature reviews (Love et al. 1989, Knight 1996) there appears to be no research to support the dismantling of practice suites. A structured approach to teaching skills now takes place in a purpose built Skills Centre. The approach used is based on a model by Gentile (1972), which is founded upon the theoretical principles of skill acquisition. It provides a blueprint for the teaching and transference of skills, and implicit in the model is the use of skill analysis. This involves demonstration of a skill by the facilitator, followed by analysis of it by the student into its component parts; this is followed by practise. The authors were concerned, however, that the use of skill analysis to teach skills should not be reduced to a presentation of a succession of isolated tasks. The authors were also aware that a nursing skill often has a tendency to be viewed purely within the psychomotor domain, with little attention paid to the knowledge base which underpins the skill. This viewpoint may contribute to the notion of a theory-practice gap. In response to these concerns, the authors have developed the Skill Grid. The grid incorporates skill analysis with Carper's theoretical framework: Fundamental Ways of Knowing (Carper 1975). The authors believe that knowledge which exemplifies nursing practice has many dimensions, and that it is crucial for students to explore the derivation of knowledge from an ontological perspective. Carper's framework will enable consideration of knowledge originating not only from empirical, but also aesthetic, personal and ethical sources. An essential feature of the grid is the attempt to link knowledge with practice by demonstrating how Carper's framework, which identifies sources of knowledge, can form the basis for the acquisition of skill. The authors have also incorporated problem-based learning into their teaching, so that the skills are practised within a patient/client orientated situation.

Attitude of Health Personnel↗
PubMed2004

Paediatric oncology nurse education: the development of a national framework.

BACKGROUND: It is recognized that there is a need for specialist nursing courses in a range of paediatric nursing specialities. Paediatric oncology nurses are facing challenges with clinical advances and the need for specialized care. At present there are no available courses in Scotland offering preparation for nurses working in a paediatric oncology setting. AIMS AND OBJECTIVES: This project, supported by Macmillan Cancer Relief, addresses this deficit by developing a comprehensive framework for a small and widely dispersed speciality. METHODS: Information on the needs and expectations of nurses and service managers in this field was obtained through postal questionnaires and focus groups. Due to the need for collaboration between higher educational institutions and service colleagues the views of educators were also established through questionnaires and semi-structured interviews. RESULTS: Problematic practice issues were cited and these issues were further discussed and recognized as the main educational needs. Availability and accessibility of education were of great importance. CONCLUSION: The framework developed aims to provide ongoing opportunities for continuing professional development within this speciality. Development of the educational framework is required to provide a course accessible to a wide geographical area of nurses. RELEVANCE TO CLINICAL PRACTICE: A National Framework for Paediatric Oncology Nurse Education was developed in response to views of experts working in the field, to the views of other stakeholders and to what is known about needs and preferences of children with cancer and their families.

Attitude of Health Personnel↗
PubMed2005

"I can put the medicine in his soup, Doctor!".

The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the medication actually serves to restore autonomy. We discuss these issues in the context of a young man with schizophrenia. His mother had been giving him antipsychotic medication covertly in his soup. Should the doctor continue to provide a prescription, thus allowing this to continue? We discuss this case based on the "four principles" ethical framework, addressing the conflict between autonomy and beneficence/non-maleficence, the role of antipsychotics as an autonomy restoring agent, truth telling and the balance between individual versus family autonomy.

Administration, Oral↗
PubMed1988

Lymphotoxin.

LT was one of the first lymphokines to be described and has been one of the most difficult to fit into a conceptual framework. Now, 20 years after its discovery, its structure, genetic organization, and linkage are well understood in mouse and human, and insight has been gained into its biological role. It is a T cell-derived glycoprotein of 25 kd coded by a gene within the MHC. It is somewhat (35%) structurally homologous to the macrophage product TNF. The genes for LT and TNF are tightly linked, and the proteins share most biological activities and compete for the same cell surface receptor. LT is induced in an antigen-specific MHC restricted fashion from class I and class II restricted T cells. Viral infection is also associated with LT production by lymphoid cells. LT has several effects on target cells including killing, growth stimulation, and induction of differentiation. The mechanism of LT's effects involves receptor binding and internalization and several sequelae including changes in prostaglandins and chromosome integrity. LT probably plays several biological roles. It can contribute to immunoregulation, defense against viruses, parasitic infections, and rejection of tumors. Understanding LT's role in the pathogenesis of diseases of autoimmunity and immune dysregulation will be the key to devising effective regimens for prophylaxis and treatment.

Amino Acid Sequence↗
PubMed1998

Responsibilities of the psychotherapy supervisor.

The art and skill of psychotherapy supervision and its teaching have received relatively little attention compared to their importance in psychiatric education. Supervision is a complex task, requiring teaching and clinical skills, as well as an awareness of the numerous responsibilities of the position. We describe the responsibilities of the supervisor and group them to include those to the supervise, to the patient, to the training program and profession, and to the supervisor himself or herself. The core responsibility to supervise is teaching them how to be psychiatrists, which for supervisors requires a balance between a hierarchical and collaborative approach. The primary responsibility to patients is that of assuring satisfactory treatment. Evaluating supervise within an educational framework is the primary responsibility to the training program and profession. Finally, the responsibilities to the supervisors themselves include self-examination during the supervision process and general ongoing education. Several themes are highlighted. One theme, which is a central development in the understanding of supervision, is seeing the supervisor as a participant in the supervisory process, rather than an outside observer of the therapy process. Another theme is that these responsibilities are at times competing, requiring the supervisor to establish priorities. Vignettes are used throughout to illustrate the problems and subtleties of supervision.

Adult↗
PubMed2003

Emergent patterns in the regulation of pharmaceuticals: institutions and interests in the United States, Canada, Britain, and France.

Although industrialized nations regulate pharmaceuticals to ensure their safety and efficacy, they balance these concerns with those related to the timeliness of the approval process and the burdens involved in meeting regulatory criteria. The United States, Canada, Britain, and France have adopted different approaches to the regulation of pharmaceuticals that place varying emphases on these competing goals and involve the participation of private interests to different extents. The regulatory approval processes and the government-industry relationships inherent within them are compared in the United States, Canada, Britain, and France by analyzing five features that distinguish the U.S. pluralist from the European corporatist approaches to policy development: representation (internal versus external), process (closed versus open), stance (informal, accommodative versus formal, adversarial), institutional power (fragmented versus centralized), and resources. An institutional framework further characterizes these approaches as based on models of managerial discretion and adjudication (United States), consultation (Canada), and bargaining (Britain, France) to clarify the patterns that emerge. While the approach that most effectively supports product safety involves managerial discretion as occurs in the United States, formal mechanisms for negotiation might be incorporated rather than a reliance on the judicial process. In an era of globalization and regulatory harmonization such divergence has significant implications. First, where harmonization in Europe involves the mutual recognition of one country's product licensing decision by the others, differences in evaluative processes remain important. Second, as harmonization leads to a common set of regulatory criteria, the criteria adopted tend to be those of nations with the least stringent regulatory standards, making evident the need for more responsive systems of post-market surveillance to protect the public interest.

Canada↗
PubMed2006

Environments of care: a curriculum model for preparing a new generation of nurses.

This article provides a perspective on the community-based curriculum model that has guided undergraduate education for the past decade, discusses some of the problems that have emerged with the community-based approach, and proposes an alternative approach for consideration and discussion. The community-based model is discussed in relation to three major areas of concern: faculty and preceptor implementation of the curriculum, entry into practice and hiring pattern disjunctions, and trends and unexpected consequences of changes in the health care system. The Environments of Care Model, proposed as an alternative curriculum approach, conveys a broad perspective on health and illness, based on a multiple determinants of health paradigm and a systems framework.

Community Health Nursing↗
PubMed2002

Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study.

OBJECTIVES: The goal of this study was to develop a psychometric instrument that classified physiciansamprsquo response styles to new information as seekers, receptives, traditionalists, or pragmatists. This classification was based on specific combinations of 3 scales: (a) belief in evidence vs experience as the basis of knowledge, (b) willingness to diverge from common or previous practice, and (c) sensitivity to pragmatic concerns of practice. The instrument will help focus efforts to change practice more accurately. STUDY DESIGN: This was a cross-sectional study of physician responses to a psychometric instrument. Paper-and-pencil survey forms were distributed to 3 waves of physicians, with revision for improved internal consistency at each iteration. POPULATION: Participants were 1393 primary care physicians at continuing education events in the Midwest or at primary care clinic sites in the Veteransamprsquo Health Administration system. OUTCOMES MEASURED: Internal consistency was measured by factor analysis with orthogonal rotation and Cronbachamprsquos alpha. RESULTS: A total of 1287 usable instruments were returned (106, 1120, and 61 in the 3 iterations, respectively), representing approximately three fourths of distributed forms. Final scale internal consistencies were a = 0.79, b = 0.74, and c = 0.68. The patterns of scores on the 3 scales were consistent with the predictions of the theoretical scheme of physician types. The "seeker" type was the rarest, at fewer than 3%. CONCLUSIONS: It is possible to reliably classify physicians into categories that a theoretical framework predicts will respond differently to different interventions for implementing guidelines and translating research findings into practice. The next step is to demonstrate that the classification predicts physician practice behavior.

Adult↗
PubMed2005

Pathological lying revisited.

Although pathological lying was first described in the medical literature over 100 years ago, it remains a poorly understood concept. Psychiatrists continue to grapple with the full ramifications of the condition, even though interest specifically in pathological lying seems to have waned in recent times. The impact of pathological lying deserves critical attention from forensic psychiatrists because of the implications that untruths have in a legal context. In this article, the authors review the considerable vagueness and confusion that has surrounded this concept and examine the extent to which a person can control lying behavior and the related question of whether pathological liars have responsibility for their actions. While providing a structured framework for considering pathological lying in the forensic context, the authors conclude that further systematic research is needed to resolve the questions raised in this article.

Adult↗
PubMed2006

Advance health directives.

Case histories are based on actual medical negligence claims or medicolegal referrals, however, certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. The aim of this article is to outline the legislative framework in relation to advance health directives and enduring powers of attorney or guardianship, with a particular focus on the medical and legal issues of relevance with respect to an assessment of mental capacity.

Advance Directives↗
PubMedDate not supplied

Achieving a professional practice model. How primary nursing can help.

The authors of this article show how a change to primary nursing causes a series of predictable changes in hospital organizations and nursing departments. They conceptualize the series of changes as a continuum. Using their continuum as a framework, they analyze primary nursing at six acute care hospitals, noting how the changes in nursing practice affect seven key variables in the organization. Nursing leaders may wish to use the insights provided by the framework to push their organizations further toward the goal of more autonomy, power, and achieving a model of professional practice.

Authoritarianism↗
PubMed1996

Functional interactions among members of the Myc superfamily and potential relevance to cutaneous growth and development.

Myc family oncoproteins function as sequence-specific transcription factors that are believed to regulate the expression of genes governing cellular growth, differentiation, and programmed cell death. Activities of Myc are countered by those of Mad and Mxi1, two related members of the Myc superfamily. Mad and Mxi1 compete with Myc for common elements and interact with putative transcriptional repressors. While the precise role of the Myc superfamily in cutaneous biology remains to be determined, findings from a number of organ systems suggest that the regulated expression and function of its members are intimately correlated with proper development and physiology. Reviewed here are current data on Myc superfamily function with references where relevant to cutaneous processes with the ultimate goal of providing a framework upon which these proteins can be exploited in gene therapeutic approaches for diseases of the skin, including neoplasia.

Animals↗
PubMed2001

Quality use of medicines (QUM) in critical care: an imperative for best practice.

Quality use of medicines (QUM) as a discrete concept is gaining increasing importance in Australia and is supported by a policy platform which has federal government and health professional support. The QUM movement is also supported by a strong consumer base and this lobby group has been responsible for endorsement as a major health initiative. However, the importance of QUM to achievement of optimal patient outcomes has not achieved sufficient recognition in the critical care literature. Implicit in the discussion of QUM is the rational, ethical, safe and effective use of drugs within a best practice framework. Successful implementation of QUM requires appropriate infrastructure and the commitment and cooperation of medical, nursing and pharmacy staff. Support, education and training provide the prerequisites of knowledge, skills and awareness for quality use of medicines for all groups. An emphasis upon evidence based practice and the prevalence of polypharmacy in contemporary health care systems requires examination of factors that are barriers to best practice. QUM in critical care areas requires appropriately skilled staff who are competent to manage patients with a wide range of selected drugs, often in highly stressful situations. In many situations in critical care, the role of the critical care nurse is one of patient advocate. It is important to note that the delivery of critical care is not limited to a discrete setting and is inclusive of management at the trauma scene, assessment and delivery of care in the emergency department, through to intensive, coronary care and high dependency units. This paper presents a discussion of the concept of QUM and its relevance in the critical care context. Key theoretical, policy and research considerations for establishment of QUM in critical care are reviewed and discussed. This paper seeks to describe key issues in QUM and endorse the need for a research agenda in critical care.

Australia↗
PubMed2003

Actualizing Gadow's moral framework for nursing through research.

The purpose of this paper is to describe how Sally Gadow's perspectives on existential advocacy as the moral framework for the nurse-patient relationship were synthesized with a general theory of motivation, self-determination theory (SDT), to inform the design of a study in which the influence of interpersonal care on the process of tobacco dependence treatment was explored. Consistent with the tenets of existential advocacy, participants who perceived their care providers as interpersonally sensitive and bringing more of their whole selves to the care encounter reported more autonomous motivation and felt competence for stopping smoking. The integration of existential advocacy with SDT, which led to the empirical work in which Gadow's ideas were actualized and her model supported, is described. Study findings are discussed in light of Gadow's philosophical views, and implications for nursing highlighted.

Humans↗
PubMed1991

Consent to mental health treatment: a theoretical analysis of coercion, freedom, and control.

Research has shown that substantial numbers of mental health patients may be coerced into 'voluntary' treatment. This article examines the concept of coercion to address the concerns of social scientists, treatment providers, and policy makers to know when coercion into treatment has occurred. This logically takes precedence over the second important question of whether or not coercion is desirable in some situations. A review of the scientific research on coercion and related topics of freedom, control, and choice leads to a theoretical framework in which coercion is defined in terms of opportunities to choose among courses of action. Implications of this analysis are drawn for mental health service delivery, mental health policy, and mental health research.

Choice Behavior↗
PubMed2005

Packaging: a grounded theory of how to report physiological deterioration effectively.

AIM: The aim of this paper is to present a study of how ward-based staff use vital signs and the Early Warning Score to package physiological deterioration effectively to ensure successful referral to doctors. BACKGROUND: The literature tends to emphasize the identification of premonitory signs in predicting physiological deterioration. However, these signs lack sensitivity and specificity, and there is evidence that nurses rely on subjective and subtle indicators. The Early Warning Score was developed for the early detection of deterioration and has been widely implemented, with various modifications. METHOD: The data reported here form part of a larger study investigating the practical problems faced by general ward staff in detecting physiological deterioration. During 2002, interviews and observations were carried out using a grounded theory approach, and a total of 44 participants were interviewed (30 nurses, 7 doctors and 7 health care support workers). FINDINGS: Participants reported that quantifiable evidence is the most effective means of referring patients to doctors, and the Early Warning Score achieves this by improving communication between professionals. Rather than reporting changes in individual vital signs, the Early Warning Score effectively packages them together, resulting in a much more convincing referral. It gives nurses a precise, concise and unambiguous means of communicating deterioration, and confidence in using medical language. Thus, nurses are empowered and doctors can focus quickly on identified problems. CONCLUSION: The Early Warning Score leads to successful referral of patients by providing an agreed framework for assessment, increasing confidence in the use of medical language and empowering nurses. It is essential that nurses and nursing students are supported in its use and in developing confidence in using medical language by continued emphasis on physiology and pathophysiology in the nursing curriculum.

Clinical Competence↗
PubMed2005

Fetuses with neural tube defects: ethical approaches and the role of health care professionals in Turkish health care institutions.

Neural tube defects (NTDs) are very serious malformations for the fetus, causing either low life expectancy or a chance of survival only with costly and difficult surgical interventions. In western countries the average prevalence is 1/1000-2000 and in Turkey it is 4/1000. The aim of the study was to characterize ethical approaches at institutional level to the fetus with an NTD and the mother, and the role of health care professionals in four major centers in Turkey. The authors chose perinatology units of four university hospitals and prepared questionnaires for the responsible professionals concerning their own and their institution's ethical approaches to the fetus with an NTD and the mother. The investigation revealed that there were no institutional ethical frameworks or ethics committees available to professional teams in the units. The roles of the health care professionals and their individual decisions and approaches based on ethical principles are described. The ethical decision-making process concerning fetuses with NTDs, examples of institutional approaches to the topic and institutional frameworks, and the role of nurses and other health care professionals are all discussed, based on a literature review. The authors suggest that institutional ethical frameworks, ethics committees, professionals' ethics education and multidisciplinary teamwork should be established for critical situations such as fetuses with an NTD.

Decision Making↗