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PubMed2001

Students' and teachers' cognitions about good teachers.

BACKGROUND: Good teachers have been studied ever since Plato described how Socrates taught by asking questions of his audience. Recent findings shed light on two characteristics of good teachers: their personality and their ability. However, more attention has been paid to teachers' practices and opinions than to students' views. AIMS: The study reported here attempted to deepen our understanding of what students think about good teachers. SAMPLE: Students of four age groups (7, 10, 13, and 16 years of age) and teachers from primary and secondary schools were asked to write an essay on the good teacher. METHODS: The correspondence between conceptual items in the essays was investigated by determining the extent to which they were used in the same essays to describe good teachers. RESULTS: Correspondence analysis revealed two dimensions. The first dimension reflected the preference of students and teachers for describing the good teacher in terms of either personality or ability characteristics. The second dimension was interpreted as an orientation in the essays towards either attachment to, detachment from or commitment to school and teachers. Students and teachers were compared to establish the amount of (dis)agreement about what makes a good teacher. Primary school students described good teachers primarily as competent instructors, focusing on transfer of knowledge and skills, whereas secondary school students emphasised relational aspects of good teachers. Teachers, however, considered good teachers in the first place a matter of establishing personal relationships with their students. Consequently, primary school students and teachers disagreed about the characteristics of good teachers. In secondary education, disagreements between teachers and students were relatively small. CONCLUSIONS: The research method of collecting free essays and utilising correspondence analysis to represent conceptual items and groups of participants seems promising as long as a theoretical framework is available to interpret the resulting representation of similarities between items and groups of participants.

Adolescent↗

PubMed2005

An exploratory study of the conditions important in facilitating the empowerment of midwives.

OBJECTIVE: to explore the conditions important in facilitating the empowerment of midwives, as judged by practising midwives. DESIGN: a cross-sectional, descriptive, national survey of nurses and midwives practising in Ireland was undertaken in 2002. The questionnaire used in the survey included the 'Understanding of Empowerment Scale'. PARTICIPANTS: the data come from a larger national study of empowerment among nurses and midwives carried out by the authors in 2001/2 (Scott et al., 2003). A random sample of 4050 nurses and midwives in Ireland was obtained from the Live Register of An Bord Altranais (Irish Nursing Board). There was an overall response rate of 46% (n = 1781). Of these, 1340 people completed questionnaires, as 441 of those who replied were not in practice at the time. Of those who completed the questionnaire, 7% (n = 95) were practising midwives. Their findings are reported in this paper. MEASUREMENTS AND FINDINGS: factor analysis using the Principal Axis Factoring method of extraction and an oblique (Direct Oblimin) rotation was carried out on the Understanding of Empowerment Scale. This suggested four factors or conditions important for the empowerment of midwives: control, support, recognition and skills. KEY CONCLUSIONS: these findings relating to the conditions that facilitate empowerment in midwifery reflect the professional distinctiveness of midwifery and take into account the specific role and working environment of the midwife. IMPLICATIONS FOR PRACTICE: the identification of the important conditions to facilitate empowerment in midwifery provides a framework with which to explore ways of building on strengths and addressing weaknesses within the current situation for midwives in Ireland and elsewhere. These suggestive findings offer an opportunity to further develop a tool to measure levels of these conditions necessary to facilitate empowerment in midwifery.

Adult↗

PubMed2004

Partnership in midwifery care in New Zealand.

OBJECTIVE: to examine whether equal power is essential to the perceptions of partnership in midwifery practice and to propose an alternative model of how power might best be shared. DESIGN: a cross-sectional design was employed using the predominant methods of interview, questionnaires and thinking aloud tape recordings as triangulation of data. SETTING: two large metropolitan hospitals in Auckland, New Zealand and home birth settings. SAMPLE: Forty one independent and hospital-based midwives and 37 nulliparous women at low obstetric risk for whom labour care was provided. FINDINGS: the majority of the midwives and the women in the two studies presented believed they had achieved a midwifery partnership with little emphasis placed on the need for equality in decision making. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the model proposed provides a framework that identifies how power can be shared without the need for equality. The integration of this model into practice may assist midwives and women to recognise and utilise differences in their experience and knowledge to achieve their aims of achieving a partnership and a successful birth.

Adult↗

PubMed1995

Rethinking alternatives to guardianship.

This article describes, compares, and analyzes the roles and functions of guardianship and several decision-making interventions previously identified as potential alternatives to guardianship. An analytical framework, comprised of capacity, risk, complexity, and support, is developed to assess performance expectations and identify limitations of four types of decision-making interventions. Using case examples to illustrate how the framework applies to practice, the capacity of different types of interventions to address needs and to substitute or divert older adults from guardianship is examined. The article concludes with propositions introduced to guide future research.

Aged↗

PubMed1999

Informed consent and the refusal of medical treatment in the correctional setting.

Authors note that the legal framework courts use for analyzing patients' decisions to refuse treatment does not accommodate the ethical issues arising when such decisions are made by patients in correctional settings. In lieu of the traditional model, they propose a more cautious approach when inmates refuse life-sustaining medical treatment.

Ethics, Medical↗

PubMed2004

A narrative study of nursing art in critical care.

The purpose of this study was to describe nursing art from the perspective of patients who had been nursed in a critical care unit. The study pursued two objectives: (a) to generate stories of occasions in which nursing was considered art in a critical care setting and (b) to describe the meanings made manifest in those stories. Using a narrative inquiry, 10 persons were interviewed twice for the purpose of answering the research question. Stories were generated in open-ended interviews, tape recorded, and analyzed by the primary researcher using Van Manen's hermeneutic phenomenological framework. Five themes were found to represent critically ill persons' experience of nursing art: (a) perpetual presence, (b) knowing the other, (c) intimacy and agony, (d) deep detail, and (e) honoring the body. The stories cultivated a human face and contextual detail for the abstract holistic concept of nursing art.

Adult↗

PubMed2006

Barriers to implementing an integrated care pathway for the last days of life in nursing homes.

AIM: this paper explores the barriers that needed to be overcome during the process of implementing an integrated care pathway for the last days of life as a way of developing quality end-of-life care in nursing homes. METHODS: an action research methodology underpinned the study. Qualitative and quantitative data were collected in eight nursing homes before, during and after the implementation of the care pathway. FINDINGS: six main barriers were identified: a lack of knowledge of palliative care drugs and control of symptoms at the end of life; lack of preparation for approaching death; not knowing when someone is dying or understanding the dying process; lack of multidisciplinary team working in nursing homes; lack of confidence in communicating about dying; some nursing homes are not ready or able to change. These findings highlight a functional 'rehabilitative' culture that may not be so appropriate in the current context of nursing home care, and one that makes implementing an integrated care pathway for the last days of life less straightforward than in other settings. CONCLUSION: it cannot be presumed that the implementation of a care pathway for the last days of life in nursing homes is straightforward. This study suggests that an action research framework was extremely useful in highlighting and overcoming some obstacles when developing evidence-based practice. Action at both local and public policy level is required to fully address barriers that prevent quality end-of-life care in nursing homes.

Aged↗

PubMed2006

Death the great leveller? Towards a transcultural spirituality of dying and bereavement.

AIMS AND OBJECTIVES: This paper aims to provide a critical engagement with the subject of transcultural spirituality and nursing practice in the context of dying and bereavement. BACKGROUND: There has been considerable interest in the subject of spirituality over the past decade, and a particular association between the study of death and the study of spirituality. The nursing literature has been at the forefront of these developments amongst health and social care professionals. Some of this literature has begun to address the issues raised for culturally competent practice and the significance of patients' belief systems in the diverse cultural contexts with which nurses must engage in contemporary health care. However, the author argues that understanding of the range of contemporary spiritualities and transcultural practice is at an early stage. METHODS: Transcultural spirituality is explored through a critical review of the literature, including the author's own published research on spiritual and philosophical issues in death, dying and bereavement. CONCLUSION: The conclusion is drawn that some common themes and approaches can be found which offer a framework to guide nursing practice with the individual patient and family. RELEVANCE TO CLINICAL PRACTICE: In the absence of guidance, nurses struggle with implementing spiritual care in the fluid and complex context of contemporary spiritualities and frequently resort to broad categorizations. This paper opens up a way of connecting with the unique spiritual position of each patient.

Attitude to Death↗

PubMed2001

Managed care for Medicare: some considerations in designing effective information provision programs.

Consumer information-processing theory provides a useful framework for policy makers concerned with regulating information provided by managed care organizations. The assumption that consumers are rational information processors and providing more information is better is questioned in this paper. Consumer research demonstrates that when faced with an uncertain decision, consumers adopt simplifying strategies leading to sub-optimal choices. A discussion on how consumers process risk information and the effects of various informational formats on decision outcomes is provided. Categorization theory is used to propose guidelines with regard to providing effective information to consumers choosing among competing managed care plans. Public policy implications borne out of consumer information-processing theory conclude the article.

Age Factors↗

PubMed2003

Ethical aspects of research into the etiology of autism.

Advances in understanding autism and other developmental neuropsychiatric disorders will come from an integration of various research strategies including phenomenologic, functional neuroimaging, and pharmacologic methods, as well as epidemiologic approaches aimed at identifying genetic and environmental risk factors. The highly heritable nature of autism makes it scientifically valuable to involve parents and siblings as research participants. However, many studies on autism pose ethical challenges because they do not offer the prospect of direct benefit to subjects. In this article, we present an in-depth ethical analysis of current nontherapeutic research strategies that are common in autism research. The ethical analysis applies a proposed ethical framework for evaluating clinical research focusing on seven ethical requirements: (1) social or scientific value, (2) scientific validity, (3) fair subject selection, (4) favorable risk-benefit ratio, (5) independent review, (6) informed consent, and (7) respect for potential and enrolled research participants.

Autistic Disorder↗

PubMed1991

Thoughts and feelings and things: a new psychiatric epistemology.

Epistemology--the study of knowledge--is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology. The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry--(1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry--can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.

Humans↗

PubMed1998

Temporal encoding as a determinant of overshadowing.

Three conditioned lick suppression experiments explored the effects on overshadowing of the temporal relationships of two conditioned stimuli (CSs) with an unconditioned stimulus (US). Assuming overshadowing is maximal when the potential information conveyed by two competing CSs is equivalent, the temporal coding hypothesis predicts that greater overshadowing will be observed when the CSs share the same temporal relationship with the US. Rats were exposed to an overshadowing CS that had either a forward, simultaneous, or backward relationship to the US. The relationship of the overshadowed CSs to the US was either forward (Experiment 1), simultaneous (Experiment 2), or backward (Experiment 3). The greatest amount of overshadowing was observed when both CSs had the same temporal relationship to the US. The data are discussed within the framework of the temporal coding hypothesis and of alternative models of Pavlovian conditioning based on the informational hypothesis.

Animals↗

PubMedDate not supplied

Maintaining career marketability as a professional nurse.

As we rush around attending to the essentials of our lives (family, friends, clients, employers), what is left? Nursing Forum invites readers to engage in thoughts and activities that may awaken an untouched place. We hope these writings will kindle your personal involvement in something that was previously avoided--because of bias, fear, or uneasiness--in order to stretch your mind and spirit. The ability to be competitive in the shifting marketplace of professional nursing practice is dependent upon a nurse attaining the credentials or experiences being sought. Identifying those knowledges and skills and developing a working plan to achieve them is essential. The Career Development Work Plan presented here is the framework to help do that, and the accompanying Professional File Management system provides the mechanism to monitor and document achievements and abilities over time. This career development approach provides the foundation and preparation nurses will need when presenting themselves to the professional job market.

Career Mobility↗

PubMed2026

Mapping the de-implementation of traditional diagnostic tests in pediatric acute lymphoblastic leukemia.

INTRODUCTION: Advances in cancer diagnostics raise questions about when and how to de-implement traditional approaches; however, these processes remain poorly described. At St. Jude Children's Research Hospital (SJCRH), routine conventional cytogenetics for pediatric acute lymphoblastic leukemia (ALL) diagnosis was de-implemented in 2018 following adoption of clinical genomics. This study aimed to map this process to inform future diagnostic de-implementation initiatives. METHODS: Interviews were conducted with SJCRH staff involved or impacted by cytogenetics de-implementation. Data were analyzed using thematic and rapid qualitative analysis informed by the Consolidated Framework for Implementation Research. Member-checking was used to verify and refine process maps, which were subsequently reviewed by an external expert panel, representing diverse settings, through focus group discussions. RESULTS: Thirteen SJCRH clinicians participated. De-implementation was described as successful, with no negative impact on patient outcomes. Decision-making began with internal correlation studies that demonstrated superior diagnostic performance of clinical genomics. De-implementation was viewed as a natural evolution that improved molecular classification, resource allocation, and workflow efficiency. Perceived risks included loss of cytogenetics competency, delayed turnaround time, and career insecurity, all addressed institutionally. Lessons learned highlighted the importance of deliberate discussion about logic and evidence supporting de-implementation. Fifteen external experts offered suggestions to improve process map generalizability, highlighting institutional- and system-level considerations. CONCLUSION: De-implementation of cytogenetics in ALL in favor of clinical genomics was successful at SJCRH. This study offers an example of diagnostic de-implementation in cancer care and proposes a structured approach to guide future efforts. De-implementation should be considered alongside introduction of novel diagnostic approaches.

cancer diagnostics↗

PubMed1994

Hypertension in the elderly. Implications and generalizability of randomized trials.

OBJECTIVE: To estimate morbidity and mortality benefits of drug therapy for hypertensive elderly subjects, compare these benefits with effects in younger subjects, and provide a framework for generalizing results derived from trials to actual patients. DATA SOURCES: A literature search using MEDLINE from 1966 to 1993, references from reviews and trial articles, and experts. STUDY SELECTION: Randomized trials lasting at least 1 year that evaluated effects of drug treatment on morbidity and mortality outcomes in hypertensive persons. DATA EXTRACTION: Four independent reviewers appraised protocol characteristics and quality of selected trials. DATA SYNTHESIS: There were 13 trials involving 16,564 elderly persons (age 60 years and older). The prevalence of cardiovascular risk factors, cardiovascular disease, and competing comorbid diseases was lower among trial participants than the general population of hypertensive elderly persons. When the six large high-quality trials were combined, trial results showed 43 subjects (95% confidence interval [CI], 31 to 69) and 61 subjects (95% CI, 39 to 141) needed to be treated for 5 years to prevent one cerebrovascular event and one coronary heart disease event, respectively. Including the other seven trials did not change the results significantly. Only 18 subjects (95% CI, 14 to 25) needed to be treated to prevent one cardiovascular event (cerebrovascular or cardiac). Twelve trials in primarily younger and middle-aged adults involved approximately 33,000 persons. For all outcomes except cardiac mortality, two to four times as many of the younger subjects as the older subjects needed to be treated for 5 years to prevent morbid and mortal events. No significant effect on cardiac mortality was seen among younger subjects, while 78 older subjects (95% CI, 50 to 180) needed to be treated to prevent a fatal cardiac event. CONCLUSIONS: Randomized trials demonstrate that treating healthy older persons with hypertension is highly efficacious. Five-year morbidity and mortality benefits derived from trials are greater for older than younger subjects. Extrapolating benefits from trials to individual patients is difficult, but should take into account multiple issues including the patient's risk factors, preexisting cardiovascular disease, and competing comorbid illnesses.

Age Factors↗

PubMed1981

Client perceptions in an initial interview as a function of therapist sex and expertness.

Therapy has been construed as a interpersonal influence process (Johnson & Matross, 1977; Strong, 1978). Consistent with that framework the present study investigated the effects of therapist sex and level of expertness on the perceptions of Ss in an initial interview. Male and female interviewers who were introduced as expert or nonexpert met individually for a 15-minute period of time with 60 male undergraduates. The Ss then rated the interviewers on perceived expertness, attractiveness, trustworthiness, persuasiveness, and their liking for the interviewer. Results indicated that male experts were rated lower in social attractiveness; however, introductions did not affect either perceived expertness or trustworthiness. The results suggest that reasonably competent therapist behavior may result in neutralizing sources of differential expertness. However, the degree of expertness may be used as a source of differential social or interpersonal attraction.

Adolescent↗

PubMed1975

Sexual conseling of the physically disabled.

Sexual satisfaction and feelings of self-esteem play an important role in the ability to adapt to an acquired physical disability. A framework has been presented to show how sexual function is affected by different types of physical disability, and spinal cord injury has been selected as a specific example. Sexual counseling for the disabled differs little from that for the able-bodied--the same principles apply. It is appropriate to remind not only the counselor but also the disabled that (1) loss of sensation does not mean loss of feelings, (2) loss of potency does not mean loss of ability, (3) loss of urinary continence does not mean loss of penile competence, and (4) loss of genitalia does not mean loss of sexuality.

Attitude to Health↗

PubMedDate not supplied

Community-based research--a framework for problem formulation: the case of upper endoscopy for gastroesophageal reflux disease.

OBJECTIVE: To identify clinical hypotheses and information gaps underlying disagreement about the use of upper gastrointestinal endoscopy (EGD) for the diagnosis of gastroesophageal reflux disease (GERD), and to design a registry study to test these hypotheses. DESIGN AND SETTING: Structured group discussions with community-based practicing gastroenterologists. RESULTS: Thirty-three gastroenterologists from 17 sites discussed a set of clinical scenarios concerning the use of EGD in GERD patients with different clinical histories. Clinicians identified patient characteristics and outcome variables missing from the original problem formulation. Using decision tables, the combinations of patient characteristics that provoked disagreement among clinicians were determined. The resulting decision tables specified which characteristics and outcome variables should be measured to test competing clinical theories of when to use EGD in patients with GERD. Subsequently, the clinicians conducted a practice-based study measuring uncertain variables associated with disagreement about the need for EGD in specific clinical situations. CONCLUSION: A structured, but flexible, approach to group discussion may help identify factors that are important in decision making and the hypotheses that should be addressed in resolving variations in practice styles. Technology assessors can use these methods to identify variables underlying clinicians' concerns about the clinical validity of recommendations about practice. This experience with eliciting patient characteristics and uncertain variables underscores the importance of involving practicing clinicians in the process and could be a useful model for problem formulation in guideline development and in community-based research.

Adult↗