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PubMed2006

Education leadership in the clinical health care setting: a framework for nursing education development.

This paper describes how a new framework for clinical nursing education was introduced at Counties Manukau District Health Board (CMDHB), New Zealand. The project was initiated in response to the significant legislative and post registration nursing education changes within New Zealand. The journey of change has been a significant undertaking, and has required clear management, strong leadership, perseverance and understanding of the organisation's culture. The approach taken to managing the change had four stages, and reflects various change management models. The first stage, the identification process, identified the impetus for change. Creating the vision is the second stage and identified what the change would look like within the organisation. To ensure success and to guide the process of change a realistic and sustainable vision was developed. Implementing the vision was the third stage, and discusses the communication and pilot phase of implementing the nursing education framework. Stage four, embedding the vision, explores the process and experiences of changing an education culture and embedding the vision into an organisation. The paper concludes by discussing the importance of implementing robust, consistent, strategic and collaborative processes--that reflect and evaluate best educational nursing practice.

Attitude to Health↗

PubMed1996

Clinical supervision: from rhetoric to accident and emergency practice.

Clinical supervision is firmly on the nursing agenda and, when implemented, will affect every practising nurse. However, current literature offers little in the way of advice on the practical application in a setting like the Accident and Emergency department (A & E). The aim of this article is to encourage A & E nurses to consider how clinical supervision can best be implemented into their current practice. A framework is presented to show how one A & E department has embraced the concept of clinical supervision and incorporated in into their A & E nursing practice. The evaluation, to date, has been positive and A & E nurses have reported that they enjoy the sessions and consider clinical supervision to be a useful learning experience.

Clinical Competence↗

PubMed2003

Adverse events in drug administration: a literature review.

Discussions between the children's services manager at an National Health Service trust, and a children's nursing lecturer from the trust's partnering university clarified that there was a need to establish a greater understanding of the local circumstances surrounding adverse events in drug administration - particularly when those events involved nurses. Indeed it is claimed that nurses spend up to 40% of their time administering drugs. It was agreed that a collaborative research study, specifically designed to explore the nature of drug administration errors, could inform future trust policies and procedures around both drug administration and error, as well as the various university curricula concerning drug administration. This study, supported by senior management in the trust, and the chair of the local research ethics committee, has commenced. The first part of this study -- an introductory literature review, is presented here. The work of O'Shea [J Clin Nurs (1999)8:496-504] is significant in structuring the review that bears a number of recurring themes. It is not the intention of this literature review to reappraise O'Shea's original critique but to expand on her work, offer a contemporaneous perspective in the light of studies and reports published since 1999, and reset the topic in the context of clinical governance. This literature review has already provided an underpinning framework for a pilot questionnaire to staff who have been involved in drug administration errors and is also the basis for curricular input to preregistration students on the subject of risk management and drug administration. In conclusion, several recommendations about the shape of future research are offered.

Adverse Drug Reaction Reporting Systems↗

PubMedDate not supplied

Practice development: individualized care.

This article describes the development of a person-centred approach to working with older people. The main focus is on developing the ward leader as a key facilitator of practice development work. This process was enabled through external facilitation of the role and project management. The stages of the project work are outlined using an established practice development framework, which ensured a systematic approach to the change process. Registered nurses developed their skills and knowledge in clinical leadership and by the end of the project, nursing care had moved away from meeting the physical needs of the patients only, to a more individualized approach to patient care.

Aged↗

PubMed2003

Optknock: a bilevel programming framework for identifying gene knockout strategies for microbial strain optimization.

The advent of genome-scale models of metabolism has laid the foundation for the development of computational procedures for suggesting genetic manipulations that lead to overproduction. In this work, the computational OptKnock framework is introduced for suggesting gene deletion strategies leading to the overproduction of chemicals or biochemicals in E. coli. This is accomplished by ensuring that a drain towards growth resources (i.e., carbon, redox potential, and energy) must be accompanied, due to stoichiometry, by the production of a desired product. Computational results for gene deletions for succinate, lactate, and 1,3-propanediol (PDO) production are in good agreement with mutant strains published in the literature. While some of the suggested deletion strategies are straightforward and involve eliminating competing reaction pathways, many others suggest complex and nonintuitive mechanisms of compensating for the removed functionalities. Finally, the OptKnock procedure, by coupling biomass formation with chemical production, hints at a growth selection/adaptation system for indirectly evolving overproducing mutants.

Algorithms↗

PubMed1985

The human T-cell receptor.

Recent studies using cloned antigen-specific T lymphocytes and monoclonal antibodies directed at their various surface glycoprotein components have led to the identification of the human T-cell antigen receptor as a surface complex comprised of a clonotypic 90-kD Ti heterodimer and the invariant 20- and 25-kD T3 molecules. Approximately 30,000-40,000 Ti and T3 molecules exist on the surface of human T lymphocytes. These glycoproteins are acquired and expressed during late thymic ontogeny, thus providing the structural basis for immunologic competence. The alpha and beta subunits of Ti bear no precursor-product relationship to one another and are encoded by separate genes. Moreover, the presence of unique peptides following proteolysis of different Ti molecules isolated by non-cross-reactive anticlonotypic monoclonal antibodies supports the notion that variable regions exist within both the alpha and the beta subunits. N-Terminal amino acid sequencing and molecular cloning of the Ti beta subunit further show that it bears an homology to the first V-region framework of immunoglobulin light chains and represents the product of a gene that rearranges specifically in T lymphocytes. Triggering of the T3-Ti receptor complex gives rise to specific antigen-induced proliferation through an autocrine pathway involving endogenous IL-2 production, release, and subsequent binding to IL-2 receptors. The implications of these findings for understanding human T-cell growth and its regulation in disease states are discussed.

Amino Acid Sequence↗

PubMed1996

Hydropower, Adaptive Management, and Biodiversity

/ Adaptive management is a policy framework within which an iterative process of decision making is followed based on the observed responses to and effectiveness of previous decisions. The use of adaptive management allows science-based research and monitoring of natural resource and ecological community responses, in conjunction with societal values and goals, to guide decisions concerning man's activities. The adaptive management process has been proposed for application to hydropower operations at Glen Canyon Dam on the Colorado River, a situation that requires complex balancing of natural resources requirements and competing human uses. This example is representative of the general increase in public interest in the operation of hydropower facilities and possible effects on downstream natural resources and of the growing conflicts between uses and users of river-based resources. This paper describes the adaptive management process, using the Glen Canyon Dam example, and discusses ways to make the process work effectively in managing downstream natural resources and biodiversity. KEY WORDS: Adaptive management; Biodiversity; Hydropower; Glen Canyon Dam; Ecology

Journal Article↗

PubMed1998

A model for integrating women's health issues into a problem-based curriculum.

The process of incorporating new material into an existing medical curriculum frequently produces lengthy debate, political maneuvering, and competition for curricular time. The faculty of the Women's Health Education Program at MCP-Hahnemann School of Medicine, developed a stepwise process, or framework, for including women's health teaching for students in the problem-based curriculum. This process can be applied to the integration of any body of information. The key elements of the process are to define the full scope of what needs to be taught, develop teaching objectives, identify opportunities to introduce the information into the curriculum, develop strategies that capitalize on existing curricula, enlist the collaboration of a broad range of key faculty, develop evaluation tools, and assess whether students have achieved the expected competencies.

Curriculum↗

PubMed2005

Statistical shape analysis: clustering, learning, and testing.

Using a differential-geometric treatment of planar shapes, we present tools for: 1) hierarchical clustering of imaged objects according to the shapes of their boundaries, 2) learning of probability models for clusters of shapes, and 3) testing of newly observed shapes under competing probability models. Clustering at any level of hierarchy is performed using a mimimum variance type criterion criterion and a Markov process. Statistical means of clusters provide shapes to be clustered at the next higher level, thus building a hierarchy of shapes. Using finite-dimensional approximations of spaces tangent to the shape space at sample means, we (implicitly) impose probability models on the shape space, and results are illustrated via random sampling and classification (hypothesis testing). Together, hierarchical clustering and hypothesis testing provide an efficient framework for shape retrieval. Examples are presented using shapes and images from ETH, Surrey, and AMCOM databases.

Algorithms↗

PubMed2003

The organisation of federal Veterinary Services in Canada: the Canadian Food Inspection Agency.

The organisational design of a national Veterinary Service is critical to the overall quality and integrity of its animal health and veterinary public health infrastructure. It is well recognised that the diversity of political, economic and social situations which exist in and between countries dictates that no one model of organisational structure can be applied to all circumstances. In Canada, a re-organisation of the approach of the federal government to food inspection in 1997 resulted in the transfer of the veterinary administration to a newly created agency called the Canadian Food Inspection Agency (CFIA). The authors provide a short background on the impetus for the creation of the CFIA and an overview of its organisational structure and responsibilities in animal and veterinary public health and food safety. Also included are the logic models that were developed for the federal Veterinary Services as part of their quality and performance management framework. Integrating all federally mandated food inspection systems under the CFIA has had concrete benefits in clarifying roles and responsibilities, reducing overlap and duplication of programme functions, improving service delivery and facilitating federal-provincial collaboration. Moreover, the strength of the organisation lies in the ability of the Canadian Veterinary Services to adhere to the fundamental principles of quality which are recommended by the OIE (World organisation for animal health) for the evaluation of Veterinary Services. No single organisational structure can guarantee a highly effective or competent Veterinary Service. Common challenges exist that may or may not be addressed in whole or in part by the organisational structure. The challenges highlighted in this paper provide further thoughts on the management of shared jurisdiction, meeting public health objectives, balancing science and political accountability, and defining the role and jurisdiction of veterinarians.

Animal Welfare↗

PubMed2004

Regulatory pathways for vaccines for developing countries.

Vaccines that are designed for use only in developing countries face regulatory hurdles that may restrict their use. There are two primary reasons for this: most regulatory authorities are set up to address regulation of products for use only within their jurisdictions and regulatory authorities in developing countries traditionally have been considered weak. Some options for regulatory pathways for such products have been identified: licensing in the country of manufacture, file review by the European Medicines Evaluation Agency on behalf of WHO, export to a country with a competent national regulatory authority (NRA) that could handle all regulatory functions for the developing country market, shared manufacturing and licensing in a developing country with competent manufacturing and regulatory capacity, and use of a contracted independent entity for global regulatory approval. These options have been evaluated on the basis of five criteria: assurance of all regulatory functions for the life of the product, appropriateness of epidemiological assessment, applicability to products no longer used in the domestic market of the manufacturing country, reduction of regulatory risk for the manufacturer, and existing rules and regulations for implementation. No one option satisfies all criteria. For all options, national infrastructures (including the underlying regulatory legislative framework, particularly to formulate and implement local evidence-based vaccine policy) must be developed. WHO has led work to develop this capacity with some success. The paper outlines additional areas of action required by the international community to assure development and use of vaccines needed for the developing world.

Developing Countries↗

PubMed1986

[The division of labor in medicine].

The regulations governing the professional training of doctors and the Nursing Law differentiate a variety of professions in the medical field. This shows that the division of labour in medicine is embodied in the law. To the undeniable advantages of rapid development and specialization in medicine are linked equally undeniable disadvantages; large hospitals find it increasingly difficult to coordinate and oversee the course of operations, an ever greater number of persons have to bear responsibilities. Not only the person who acts incorrectly, but also those connected in same way, especially those preceding in the line of action, can be called to account for unwise selection and inadequate supervision of co-workers. We have to distinguish between horizontal division of labour among persons of equal rank, and vertical division of labour and delegation within the framework of staff hierarchy. Although the principle of trust is embodied only in the Road Traffic Code, it can be widely applied to horizontal division of labour. In vertical division of labour and delegation, its reach is only qualified. Reported cases serve to exemplify the complex of problems, and the situation is discussed in the light of the legal provisions of the Medical Profession Act, the Hospital Law and the rules governing institutions. There is no unequivocal, by-operation-of-law distribution of powers or competence. The paper highlights the eminent importance of the duty of care as established in the body of law when it is a question of accepting a task with which one is entrusted and, conversely, when entrusting a co-worker with a task.

Austria↗

PubMed2006

Helping student nurses to identify and respond to the psychological needs of physically ill patients: implications for curriculum design.

It is universally accepted that nursing practice is predicated upon the notion of holistic care, in that nurses need to address not only the physical needs of ill patients but also their psychological, social, spiritual, and environmental needs. However, there is considerable evidence to suggest that nurses often inadequately identify and respond to patients' psychological needs, sometimes with adverse consequences for physical health and recovery. This may be because they do not fully understand the concept of psychological care, or have been inadequately prepared or educated to deliver it in practice. Following a summary of relevant literature and an overview of findings from a larger study of the nature and experience of psychological caregiving, this paper discusses specific findings on preparing nurses for their psychological caregiving role. The paper proposes a curriculum framework designed to enhance awareness, knowledge, and skill in effective psychological caregiving in nursing practice, to the ultimate benefit of physically ill patients. For the purposes of this paper, psychological care is taken to mean one element of the broader concept of care, rather than being synonymous with it.

Attitude of Health Personnel↗

PubMed2001

Rapport and the hospitalist.

One key issue in the hospitalist movement is the need for hospitalists to establish rapport and maintain relationships with their patients. Rapport is critical in obtaining a thorough history, and then effectively negotiating the diagnosis and treatment plan with patient and family. This article summarizes both the challenges to establishing rapport and the opportunities unique to hospital-based practice. It presents a basic framework for communication skills using the mnemonic PEARLS (partnership, empathy, apology, respect, legitimation, self-efficacy), and a detailed discussion of techniques for use in difficult relationships. The importance of the physical setting and of nonverbal skills cannot be underestimated. Rapport-building techniques can be learned but require practice.

Attitude of Health Personnel↗

PubMed1991

Evaluative perceptions of patronizing speech addressed to elders.

Within a speech accommodation framework, speech modifications based on stereotyped expectations of elderly persons (such as patronizing speech) are hypothesized to convey less respect. Adult volunteers (N = 186) read scripts of a conversation between a nurse caregiver, using either patronizing speech or a more neutral variant, and a 76-year-old nursing home resident, depicted either as alert or forgetful. Respondents viewed the nurse in the patronizing condition as significantly less respectful and less nurturant and the recipient as more frustrated. The patronizing nurse was also rated as significantly less competent and benevolent than her counterpart in the neutral condition. The ecological validity of the contrasts between scripts was confirmed by inferences that patronizing speech was more shrill, louder, and produced with more exaggerated intonation.

Adolescent↗

PubMedDate not supplied

Knowledge and power in the clinical setting.

In this paper we consider the three categories offered by Howard Brody for understanding power in medicine. In his book The Healer's Power, Brody separates out power in medicine into the categories of Aesculapian, Social, and Charismatic power. We examine these three categories and then apply them to a case. In this case set in an Obstetric ward, a junior member of the medical staff makes a clinical decision about a patient. This clinical decision is overruled by a senior medical staff member who then carries out his plan with disastrous consequences for the woman and her baby. This case challenges the three categories of power offered by Brody and highlights the need for a further category of Hierarchical power to be added to Brody's framework. We conclude by suggesting that there is a need to recognise the discrepancy in power not only between physician and patient but also between senior and junior staff in a clinical setting.

Cesarean Section↗

PubMed1993

Signaling-competent receptor chimeras allow mapping of major insulin receptor binding domain determinants.

Chimeric receptors were generated in which structurally defined subdomains of the insulin receptor (IR) and insulin growth factor-I receptor (IGF-1R) alpha-subunits were exchanged between their respective receptor backbone structures. Upon expression in human fibroblasts, nine IR/IGF-1R chimeras were transported to the cell surface, where they formed binding sites with differential properties. One IGF-1R/IR chimera (C3') exhibited to some extent high insulin specificity, demonstrating the presence of major insulin binding determinants within the amino acid 325-524 region of the IR alpha-subunit. Complementation of this region with subdomain 1 (amino acids 1-137) reconstituted full insulin binding potential within an IGF-1R framework. In addition, both the IGF-1R/IR C3' chimera and another chimera (C13') displayed high affinity binding properties for IGF-1, which suggests distinct locations for major insulin and IGF-1 binding determinants in their respective receptors, in agreement with our previous findings (Schumacher, R., Mosthaf, L., Schlessinger, J., Brandenburg, D., and Ullrich, A. (1991) J. Biol. Chem. 266, 19288-19295). The binding characteristics of all receptor chimeras correlated directly with the ability of the ligands to regulate their tyrosine kinase activity in intact cells. These results demonstrate direct coupling of ligand binding affinity and capacity for tyrosine kinase activation.

Antibodies↗

PubMed1990

Alcohol and human performance.

The present paper presents a comprehensive review of studies concerned with the effects of alcohol on human performance. It attempts to review the studies within the framework of the information processing model. The effects of alcohol on information processing and transmission rates, sensory and perceptual processes, motorcontrol processes, attentional processes, and cognitive processes are described and discussed. It is proposed that such a processes analysis of human performance is a useful vehicle to describe the specific effects of alcohol. From the review it is concluded that much of the evidence from simple task description is equivocal. However, when information load is increased, when the stimulus-response incompatibility increases, and when the number of competing information processes occur in 'parallel', then a strong, consistent and coherent pattern of performance deterioration is associated with alcohol consumption.

Journal Article↗