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PubMedDate not supplied

Latin American Guide for Psychiatric Diagnosis (GLDP).

Culturally competent diagnostic systems are necessary for an effective and ethical clinical practice, as cultural diversity of patients increase around the world. Latin American psychiatrists hold a long-standing commitment to this enterprise. Recently, two main Latin American adaptations to the international psychiatric classification have emerged: the Cuban Glossary of Psychiatry, and the project of the Latin American Guide for Psychiatric Diagnosis (GLADP). Keeping ICD-10 as the basis for nosological organization, GLADP is being developed with contributions by mental health professionals from Latin American countries. GLADP comprises 4 parts: (1) historical and cultural framework, (2) comprehensive diagnosis and formulation, (3) psychiatric nosology and (4) appendixes.

Cross-Cultural Comparison↗
PubMed1999

Using relationship marketing to develop and sustain nurse loyalty: a case of a rural health care institution.

The prosperity of a health care organization is contingent on its ability to compete for and retain a high quality staff of "loyal" nurses. Although the benefits of maintaining a loyal nursing staff are obvious, turnover in the health care industry is dangerously high. One solution for reducing turnover is to develop and sustain a loyal nursing staff. The purpose of this article is to apply customer-oriented marketing theories and practices to better understand how strong nurse-provider relationships can be developed and maintained over time. The authors first examine relationship marketing literature as it applies to nurse relationship and management issues. Second, a framework for conceptualizing internal marketing efforts devoted to enhancing nursing staff satisfaction and retention in tested. Finally, strategies for practicing relationship marketing will be provided.

Health Services Research↗
PubMed1993

Alternative patient care delivery systems: a combined ophthalmic nursing unit and a cost effective ophthalmic surgery program.

To be competitive as a tertiary facility in today's healthcare environment, our institute implemented two nursing programs using the Continuous Quality Improvement (CQI) framework: a) creation of the Nursing and Trauma Center, a nursing unit with the flexibility to adjust to continuing changes in patient mix comprising three nursing units (eye emergency room, same day surgery unit, and inpatient unit) designed to consolidate and standardize care to ophthalmic patients and develop a multi-skilled nursing staff to provide nursing care to all ophthalmic patient populations; and b) creation of the Controlled Medical Intensity (CMI) program, in which certain ophthalmic surgeries are performed in the most cost effective and efficient manner (while maintaining quality care). Conceived to compete with surgi-centers, CMI surgery is performed under local retrobulbar anesthesia with minimal, one-time intravenous (IV) conscious sedation (administered by operating room/recovery room nurses according to a standard protocol). Surgical supplies are standardized. These expanded roles have given nurses the opportunity to practice professional autonomy using nursing judgment.

Ambulatory Surgical Procedures↗
PubMed2003

Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute, long-term, and community health care environments.

In an article on a previous study involving hospitalized older adults (McCarthy, 2003), it was argued that the theory of situated clinical reasoning explains why nurses often fail to recognize acute confusion. Further, the theory illuminates how nurses' perspectives toward health in aging affect the ways they regard and ultimately deal with older people in this particular clinical situation. The purpose of the current study was to challenge and refine the theory by exploring the influence of different care environments on clinical reasoning related to acute confusion. Following a period of participant observation, a purposive sample of 30 nurses, 10 each from a teaching hospital, a long-term facility, and a home care agency, participated in semistructured interviews. Dimensional analysis provided the methodological framework for data collection and interpretation. The results reinforce prior findings that the ability of nurses to recognize acute confusion and to distinguish it from dementia can be attributed to their personal philosophies about aging. Care environment was identified as a factor that influenced clinical reasoning in limited ways under certain conditions and within certain contexts.

Acute Disease↗
PubMedDate not supplied

Social and professional support for pregnant and parenting women.

PURPOSE: A literature review to contrast the role of social and professional support in improving maternal and infant outcomes in pregnant and parenting women. In addition, recommendations are made for future research and policy and program development concerning support needed by pregnant and parenting women. DATA SOURCES: Data were limited to published studies. Searches of computerized databases, hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched (CINAHL, Medline, PsychLit, Social Sciences Abstracts, Social Sciences Citation, and Social Work Abstracts). STUDY SELECTION: The studies focused on outcomes of social support and professional support to pregnant and parenting women. The samples of the studies included pregnant women and parenting women up to 2 years postpartum. Studies reviewed were conducted in the United States or Canada and included maternal and/or infant outcomes. All ages and races of pregnant and parenting women were considered. DATA EXTRACTION: Data were extracted from each study concerning the theoretical framework, variables, sample, design, measuring instruments, interventions, and outcomes. DATA SYNTHESIS: Social support outcomes were summarized in paragraphs while a table was used to summarize professional support intervention outcomes. CONCLUSIONS: Outcomes associated with specific support interventions should be clearly identified, informed by theory, and include assisting the pregnant and parenting woman to improve her social support.

Clinical Competence↗
PubMed1997

Myth-management in the NHS.

Reviews the role of clinical directors from outside the usual managerial framework to challenge the managerial myth applied to professionals who take on these roles. Defines management, managing, managerialism and leadership and develops an empirical framework to compare the roles of doctors and managers. Uses the framework to identify the cognitive map that clinical directors use and how they perceive their role. An emergent model illustrates how clinical directors combine a new cognitive map with their existing professional behaviours to undertake their role. Clinical directors both perceived and described their role in terms of leadership rather than management reinforcing the inappropriateness of using managerial frameworks. Instead clinical directors should be developed and evaluated as professional leaders. This raises wider questions of whether management and the language of management are either useful or appropriate for professionals in the NHS or whether their value is really a myth.

Health Care Reform↗
PubMed2003

Martin's Map: a conceptual framework for teaching and learning the medical interview using a patient-centred approach.

OBJECTIVE: At the end of training, students seem to lack a basic understanding of how to take an organised, relevant medical and social history using a patient-centred approach. The aim of developing the map described in this paper was to provide a framework for such an approach. METHODS: Action research was used to continuously modify and refine an interview map that was used by medical clerks, family medicine residents, international medical graduates and practising doctors for teaching and learning purposes over a 10-year period. CONCLUSION: 'Martin's Map' provides a realistic framework for flexibly organising and integrating medical content with process that did not previously exist. The map provides medical educators with a standardised framework for talking about the medical interview, which helps learners understand how to use their medical knowledge with a patient-centred approach. Learners are able to visually see how they can take a focused medical and social history using a patient-centred approach, which subsequently seems to help them organise their thinking and approach during the medical encounter.

Clinical Competence↗
PubMed1991

A novel perspective on medical education.

Participants on a course entitled 'Planning and Evaluating a Course' generated a theoretical framework to simplify consideration of the essential components of clinically skilled behaviour. Five superordinate facets were elucidated and elaborated with reference to specific teaching situations. This paper illustrates the effective use of buzz-groups to encourage active participation of individual group members. The exercise revealed some serious shortcomings in the current teaching of clinical skills.

Clinical Competence↗
PubMed1988

Privilege delineation in a demanding new environment.

The delineation of clinical privileges is one of the most important means for hospitals to ensure high-quality care. Competition, cost control, and public accountability have created the need for hospitals to assure effective privilege delineation processes. Hospitals should focus on issues of practice variation, continuity of care, volume of services provided and planned, and the integration of ethical considerations into clinical decisions. How information is obtained, verified, and acted upon is reviewed within the organizational framework of the hospital. Several leaders within the hospital, such as the clinical department chairs and members of the medical staff executive committee, have important functions in the clinical privilege delineation process. Granting clinical privileges is a critical hospital function that requires a commitment by the governing body, management, and medical staff leaders.

Clinical Competence↗
PubMed1999

Developmental pragmatics in normal and abnormal children.

We propose a critical review of current theories of developmental pragmatics. The underlying assumption is that such a theory ought to account for both normal and abnormal development. From a clinical point of view, we are concerned with the effects of brain damage on the emergence of pragmatic competence. In particular, the paper deals with direct speech acts, indirect speech acts, irony, and deceit in children with head injury, closed head injury, hydrocephalus, focal brain damage, and autism. Since no single theory covers systematically the emergence of pragmatic capacity in normal children, it is not surprising that we have not found a systematic account of deficits in the communicative performance of brain injured children. In our view, the challenge for a pragmatic theory is the determination of the normal developmental pattern within which different pragmatic phenomena may find a precise role. Such a framework of normal behavior would then permit the systematic study of abnormal pragmatic development.

Brain Diseases↗
PubMed2002

Confusing rhetoric with reality: achieving a balanced skill mix of nurses working with children.

BACKGROUND AND RATIONALE: The option of separate registration in children's nursing has been a feature of nursing in the United Kingdom since 1919, but this is currently under review. The recently superseded governing body of nursing, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, has suggested that generic nurse registration with later specialization would be a more appropriate structure. Polarized views tend to dominate the debate over whether or not children's nursing should remain a discrete branch of nursing rather than simply another postregistration speciality. A long series of reports is often referred to in the debate, but the recommendations of these are often misconstrued and misrepresented. AIMS: First, to provide a factual historical overview of the significant reports on the provision of child health care over the past 50 years, identifying the key principles of each, and to develop from this analysis reasoned conclusions regarding the priorities in skill mix for nursing children. Second, to propose an alternative framework for nursing skill mix that will ensure that children receive care appropriate to their needs, and that nurses are appropriately prepared for the level of service to be offered. CONCLUSION: The problems associated with expectations of universal provision of registered children's nurses for all children requiring nursing intervention have resulted from misunderstandings of the recommendations of key historical reports. In the light of evidence presented for the drive for abolition of specialist registration, and the main arguments of the polar stances of genericism or specialization, it is vital that alternative strategies are developed and debated. The proposed framework, based on pragmatism and key principles established from major reports, is discussed in an attempt to address the real issues; namely that all children are cared for by nurses who have adequate preparation commensurate with their needs, and that there is a strong career trajectory for all nurses working in the field of child heath.

Child↗
PubMed2006

A survey validation of generic objectives for community-based education in undergraduate medical training.

INTRODUCTION: A framework for the definition of generic objectives for community-based education (CBE) was developed for undergraduate medical programmes, particularly for developing countries. To probe the validity of the set of CBE objectives generated by this approach, opinions from a wider audience were sought. METHOD: Questionnaires were sent to 72 medical schools in 36 developing countries. Half of the addressees were randomly drawn from the list of institutional members of The Network: Toward Unity For Health (TUFH) and stratified according to developing countries. Another 36 medical schools were randomly drawn from non-Network: TUFH schools from the same country where the selected Network: TUFH addressee was located, or from a neighbouring country. RESULTS: A total of 43 medical schools responded to the questionnaire (60% response rate), 31 out of the 36 addressed Network: TUFH members (86%) and 12 out of 36 addressed non-Network: TUFH schools (33%). Out of all 43 respondents 39 (91%) had implemented CBE in their curricula. Opinions of Network: TUFH and non-Network: TUFH schools on the framework and the generic objectives were not significantly different. Out of the 21 proposed objectives, 17 were scored as relevant by 75% or over of all responders and one out of the four objectives considered to be less relevant by the responders was deleted. CONCLUSION: A framework to develop generic CBE objectives and a derived set of 21 objectives were modified based on input by 43 medical schools residing in developing countries distributed all over the globe. The outcome is a validated set of 20 generic objectives for CBE programmes in developing countries.

Chi-Square Distribution↗
PubMed2005

The case for educating health care students in professionalism as the core content of interprofessional education.

BACKGROUND: Professional teams are becoming more central to health care as evidence emerges that effective teamwork enhances the quality of patient care. Currently, health care professionals are poorly prepared by their education for their roles on the team. In parallel, there are increasing demands from consumers for health care professionals to serve the interests of society and patients through engaging in effective professional partnerships. Professionalism for health care providers is now being defined as a commitment to standards of excellence in the practice of the profession that are designed primarily to serve the interests of the patient and to be responsive to the health needs of society. Yet, there are multiple barriers impeding the development of professionalism beyond a uni-professional frame of reference. METHOD: Incorporating teamwork and professionalism into health care professional curricula at pre-registration level is proving to be challenging. These 2 areas of learning are brought together in this paper through a discussion of the role of interprofessional education in preparing all health care professional students for the workforce. CONCLUSION: Interprofessionalism is presented as a pre-registration curriculum framework that includes values shared by all health care professionals, which should be learned in order to more adequately prepare students for working in health care teams. It will be argued that interprofessional education provides appropriate methods by which to learn interprofessionalism, and that this will ultimately contribute to overcoming uni-professional exclusivity.

Curriculum↗
PubMed2005

Clinical practice guidelines: barriers to durability after effective early implementation.

BACKGROUND: Clinical practice guidelines in general (General-CPG) may reduce variation in clinician performance and improve patient outcomes. Short-term evaluation is now routine, but demonstration of early successful implementation does not necessarily ensure longer-term effectiveness. AIM: To assess adherence to chronic obstructive pulmonary disease (COPD)-CPG recommendations at the Royal Melbourne Hospital (RMH), 2 years after successful implementation. To identify barriers to sustained success of General-CPG. METHODS: A multi-faceted evaluation was performed to document: (i) current adherence to COPD management recommendations (medical record audit); (ii) awareness of attitudes towards and barriers for the use of COPD-CPG and General-CPG (staff survey, focus groups and key informant interviews) and (iii) access to and quality of available General-CPG (internet review and random sample General-CPG evaluation. RESULTS: Adherence to COPD-CPG recommendations was highly variable. Adherence was higher in the Emergency Department than the general wards and for specific therapeutic recommendations. It was lower for non-pharmacological therapy and for recommendations relating to processes of care. Most health professionals were in favour of General-CPG. Barriers to use of General-CPG were in keeping with previous literature reports. Organizational issues including high levels of staff turnover and lack of integration of General-CPG into hospital quality frameworks were highlighted as major barriers. Hospital intranet access and presentation of General-CPG identified lack of consistency in terminology and presentation. CONCLUSION: Short-term effectiveness of COPD-CPG implementation did not ensure sustained success. Departmental organizational behaviours and organizational system barriers are major factors influencing durability.

Aged↗
PubMed2006

Changes in nursing education in the European Union.

PURPOSE: To provide an overview of changes in nursing education in the European Union (EU) within the framework of the Bologna Declaration, signed in 1999 by the European ministers of education, and to describe specific efforts and changes in Spain. ORGANIZING CONSTRUCTS: (a) the Bologna Declaration process, its recent reforms in all disciplines including nursing, and perspectives on future developments; (b) the Tuning Project, designed and carried out by a group of European universities to meet the challenges posed by the Bologna Declaration; and (c) efforts in a group of Spanish universities to promote higher education in nursing. FINDINGS AND CONCLUSIONS: These changes promote enhanced academic recognition, professionalism in nursing education, and graduates' competencies in practice in most European countries by specifying the undergraduate nursing degree as the minimal entrance level for practice and master's and doctoral programs for further career development.

Curriculum↗
PubMed1999

The family rule: a framework for obtaining ethical consent for medical interventions from children.

Children's consent to treatment remains a contentious topic, with confusing legal precepts and advice. This paper proposes that informed consent in children should be regarded as shared between children and their families, the balance being determined by implicit, developmentally based negotiations between child and parent--a "family rule" for consent. Consistent, operationalized procedures for ethically obtaining consent can be derived from its application to both routine and contentious situations. Therefore, use of the "family Rule" concept can consistently define negligent procedure in obtaining consent from children, and could be used as a unifying framework in the development of new professional guidelines. A "guideline"-based approach to children's consent to treatment may offer greater individuality than a "rights"-based approach, though careful training and oversight will be needed for it to be effective.

Beneficence↗
PubMed2001

Something for everyone? A community and academic partnership to address farmworker pesticide exposure in North Carolina.

Partnerships between academic researchers and community organizations are frequently formed to address environmental health concerns in underserved communities. Although such participatory approaches to research combine valuable assets of both partners, they are often difficult to maintain. We describe a partnership formed to investigate migrant and seasonal farmworker exposure to pesticides in North Carolina and to develop effective interventions to reduce exposure. North Carolina ranks fifth in the United States in the number of farmworkers; most are from Mexico, and a significant minority come to the United States on work contracts. Several barriers to establishing effective collaboration were recognized in this partnership, including stereotypes, cultural differences, competing demands for time and attention, and differences in orientation to power structures. To overcome these barriers, members of the partnership took actions in three domains: clarifying the different goals of each partner, operationalizing a model of participation that could involve many different community segments developing cultural sensitivity. By taking these actions, the work of the partnership was accomplished in ways that met the criteria for success of both academic researchers and community members. This approach can be used by others to develop collaborative relationships to investigate environmental health issues within a community-based participatory framework.

Adolescent↗