Biomedical subjects
A Adams
Publications and source records attributed to A Adams.
Australian nurse educators identify gaps in expert practice.
In Australia, nurses face a double-barreled challenge to their role. With the rapid adoption of new health care technologies coupled with increasing economic constraints, they find themselves "doing more with less." In this context of continuous change, it is useful to determine what expert nurse clinicians deem the most essential skills, attitudes and knowledge required for practice in complex technological environments. Separate panels of 28 educators and 43 cardiac nurse clinicians participated in a national Delphi study rating the importance to the nursing role of 107 items drawn from the international literature on expert practice and technology. Indicating the importance of each item in both the "real" and "ideal" worlds of practice, educators identified 58 items where they felt actual practice was substantially far from the ideal. For 16 of these items relating to empowerment of patients, nursing research, and technology policy, the educators rated clinical behavior below the median of the real world scale, indicating substandard performance of a role or inadequate assimilation of a concept. The implications for the definition of expert practice and for curricula development are discussed.
Theatre nursing: making the most of theatre allocation.
Explore the source record for details and available documents.
The standard guide to confronting bullying at work.
Explore the source record for details and available documents.
Nurses' perceptions of their professional growth on completion of two years of postgraduate education.
In a climate of diminishing financial resources in service industries such as health care and education, it is not surprising that a focus on measuring and ensuring appropriate outcomes is widespread. Graduate education has the potential to make a significant difference to the professional behaviour of graduates. Postgraduate nursing coursework programs have been developed and offered in such a climate, many now charging full course fees, which no doubt stimulates participants and employers to look for value for money in terms of outcomes. A ten year longitudinal study began in 1992 and was designed to determine the impact of postgraduate coursework nursing education on the careers and the professional and personal development of graduates. This paper reports graduates' perception of their personal and professional growth in terms of professional activities such as writing for publication, research, mentoring, and involvement in professional organisations at the completion of their university course. Respondents indicated the course had contributed to increased professional behaviours in all aspects and to a marked improvement in their clinical confidence. Improved self esteem and increased participation in professional activities reflects changing attitudes towards nursing work that have important implications for improved quality of patient care.
It's all in a name. When is a 'Delphi study' not a Delphi study?
As nursing researchers we need to fully understand the origins of the methods we are using in research investigations. Without an in-depth understanding, we may find ourselves violating fundamental underpinning assumptions or conventions through ignorance, and the resulting studies are unlikely to stand up to tests of congruence and rigour. This paper is a discussion of some complexities encountered while exploring the literature on the Delphi technique, a research method we had believed to be straightforward. The Delphi method had been used extensively since its development in the 1950s, and its use in nursing research appears to be increasing. Our explorations revealed that, rather than a simple means of obtaining the judgments of experts, modifications and adaptations over the years have dramatically changed 'the' Delphi. Anyone wishing to use the method needs a sound knowledge of complex theoretical issues associated with its implementation.
Australian clinicians and educators identify gaps in specialist cardiac nursing practice.
Change is endemic in both the health care and higher education sectors in Australia. Consequently professional roles and educational pathways must also evolve and adapt, often catalysed by those in leadership positions. Two national Delphi panels, one of cardiac nurse educators and the other of cardiac nurses, were convened to answer the question 'What knowledge, skills and attitudes are required for an expert nurse practising in the highly technological cardiac care environment?' Respondents indicated on a Likert scale the importance of 107 items to the nurse's role in both the 'real' and 'ideal' worlds of practice. Overall there was very strong agreement between the two panels with results indicating that Australian nurses perform close to their ideal in many areas of practice. For 31 of the items, both panels identified that the reality of practice is quite far from their ideal. Both panels agree that 10 of the behaviours are carried out or valued very little in practice. Reasons why nurses are not carrying out these elements of the role to their satisfaction are discussed and remediation strategies suggested. The findings can inform both curriculum development and clinical practice. In the dynamic health care arena, the nursing profession continues to respond to community and professional needs, seeking to establish sound research-based practice and maintain a high quality of clinical care and nursing management. The development of competencies by the Confederation of Critical Care Nurses (1996) is a good example of professional groups taking the initiative both in defining the practice role and providing tools that assist educational bodies to develop programs appropriate for a practice based discipline. Specialty nursing practice is 'under the microscope' in Australia as the profession seeks the best methods to weight nursing activities, measure nursing outcomes and recruit, retain and justify the use of specialist practitioners.
[Intracranial hemangioma].
A case of intracranial hemangioma in a neonate is described by the authors. The rarity of the condition raised differential diagnosis problems.
A meta-analysis of clinical trials of spinal manipulation.
OBJECTIVE: To assess the efficacy of spinal manipulative therapy (SMT) in the treatment of back pain using meta-analytical techniques. DATA SOURCES: The literature was systematically searched for all studies of SMT through June 1989. The Index Medicus from 1980 was expanded by citation tracking. The Chiropractic Research Archives Collection was utilized as a regularly updated bibliographic source for the location of research publications. A hand search of professional chiropractic journals was also undertaken. STUDY SELECTION: Studies in English with concurrent controls treated by methods other than SMT, including sham, produced 23 randomized controlled clinical trials of the effectiveness of spinal manipulation. Because a single trial might include more than one comparison of treatments, these trials produced a total of 34 mutually exclusive, discrete samples. DATA EXTRACTION: Data were extracted via a standardized coding document by one author and verified by two of the others. Data were independently extracted from a subset of the studies by a blinded research assistant to ensure that coding methods produced acceptable consistency. DATA SYNTHESIS: Effect sizes (Cohen's D index) were calculated for nine outcome variables at eight time points following the initiation of treatment. Thirty-eight of 44 effect sizes indicated that SMT was better than the comparison treatment. It was also found that meta-analysis was an imperfect instrument for the kind of trials that were pooled in this study because the research protocols were highly diverse. Furthermore, because the nature of SMT does not permit an easy use of placebos, true no-treatment control groups were rare. Most studies compared SMT to an alternative treatment. This probably obscured the effectiveness of SMT since the comparison treatments were presumably also effective. CONCLUSIONS: SMT proved to be consistently more effective in the treatment of low back pain than were any of the array of comparison treatments. The analysis provided some suggestion that manipulation, as such, is more effective than mobilization, as such. For the future, it is suggested that researchers strive for more consistent measures in terms of explicit descriptions of the nature of SMT, the times of post-treatment assessments and the nature of outcome measures. Only then can meta-analysis fulfill its potential in this clinical area.
A clinical comparison of anticalculus dentifrices over 4 months of use.
Explore the source record for details and available documents.
A shoulder to lean on.
Explore the source record for details and available documents.
Improved enzyme-linked immunosorbent assay for determination of soy protein in meat products.
An indirect, competitive enzyme-linked immunosorbent assay (ELISA) has been developed for quantitation of soy protein in meat products. The methodology allows rapid aqueous extraction of meat samples into a liquid form suitable for assay. The assay is highly specific for soy protein and is designed to measure soy protein levels between 1 and 10% of the wet weight of the sample. Standardized, stabilized reagents for carrying out the procedure are commercially available in a kit. The analysis, including sample preparation, can be completed within a workday, and the actual immunoassay in less than 60 min.
[Primary prevention of rheumatic fever. Occurrence of beta hemolytic Streptococcus of the A group in 11,314 students in Magdalena Contreras].
A study was made in 11,314 school-age children to determine the prevalence of streptococcus pyogenes group A. The children studied belonged to a low socioeconomic group of one of the political boroughs of the Federal District. The prevalence found was 6.86%. There were no differences in the percentage of carriage according to the school surveyed or the school grade studied. However, marked differences were found when the presence of arthralgias was related to the carriage of streptococcus. Children complaining of artharlgias showed twice as much streptococcus in their pharynx than the ones not carrying it.
FLORENCE: synthesis of case-based and model-based reasoning in a nursing care planning system.
In this article, the data structures and reasoning methodologies of FLORENCE, an expert system that advises on the identification of nursing diagnoses in a new client, are described. FLORENCE is primarily a case-based reasoning system, but has an ancillary model-based reasoning system to advise on complex problems. The use of multiple reasoning methods allows for better simulation of the reasoning process of the expert clinician.
The impact of graduate education on the career paths of nurses.
This paper reports the findings of the first phase of a ten year longitudinal study of nurses graduating with higher degrees and diplomas. The higher education sector in Australia has been subjected to a variety of changes in the past decade. Amalgamations and restructuring, altered funding formulae, recognition of prior learning and credit transfer are some of the initiatives, many dictated by governmental bodies, which impact on the education system. Within this volatile context, graduate education in nursing has developed significantly in both quality and variety. These courses have been taken up vigorously by professionals who, until 1990, had limited opportunities for tertiary study in the discipline. Perhaps one of the most significant changes within education, and interestingly paralleled in the health sector, is the move to examine more carefully the outcomes of the process or service provided. The demographic profile, career movements and career plans of graduating students over a five year period from December 1992- December 1996 are presented.