Partnerships: the way forward.
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Biomedical subjects
Publications and source records attributed to S Glen.
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BACKGROUND: The value of diving medicals in preventing incidents is uncertain and there has been only limited evaluation of the fitness to dive guidelines in a sport diving population. OBJECTIVE: To examine the need for routine diving medical examinations in the Scottish Sub-Aqua Club (SSAC) between 1991 and 1998. METHODS: A medical examination of all SSAC divers is performed at entry and then every one to five years based on their age and medical condition This information was analysed in terms of questionnaire findings and examination abnormalities. RESULTS: There were 2,962 medical forms available for analysis. Examination abnormalities were found in 174 subjects (5.9% of the population), with obesity affecting 75 subjects (2.5%). There was a linear increase in mean body mass index (r2 = 0.92), and a significant difference between 1991 and 1998 (mean (SD) of 24.1 (3.07) and 25.02 (3.4) respectively, p = 0.002) which was not related to age or sex distribution. There was also a significant increase in the prevalence of smokers (chi2 = 4.02, p = 0.045). The most common specialist referral was for evaluation of asthma, with hypertension and obesity as the next most common reasons. Most subjects were allowed to dive, with only 43 (25%) being failed outright. Overall, no examination abnormality alone caused a subject to be classified unfit to dive, and referrals were prompted by the answers in the questionnaire. CONCLUSIONS: No significant unexpected abnormalities were found on clinical examination in this population of sport divers. Conditions that prevented subjects from diving were detected by the questionnaire, and this prompted referral for further assessment by the medical advisors. Routine medical examinations were of little value.
This paper discusses role development to bring research closer to the clinical setting and describes a strategy for advancing research in clinical practice.
The requirement to support students in the clinical environment during their preparation has recently been given renewed attention. Many practitioners, managers and students are concerned that preregistration nurses are emerging from nursing education programmes without essential clinical skills. The decision to discontinue the clinical teaching role was made against a background in which low priority was ascribed to the clinical teaching role by nurse teachers when compared with a classroom role. The last few years has also been marked by far-reaching and rapid change in the environment within which the education of nurses is carried out. Against the above background, this paper explores the changing nature of the role of nurse teachers in placement areas and outlines a variety of potential new models. These include: link teacher role, the clinical teacher role, the lecturer/practitioner role and Clinical Research Fellowships. The paper proposes a radical scenario and outlines a skill mix for the future for nurse education.
This article will address the question: how can health care education best take seriously the task of educating for professional practice within a post-traditional, liberal democratic society? In the setting of modernity, the altered personal and professional self has to be explored and constructed as part of a reflective process of connecting personal and professional change: in essence, to develop self-knowledge. A moral life, or 'working morality', that evolves out of a process of ongoing dialogue and conversation is required. What is advocated here is a more social model of health care education that acknowledges a social or communal dimension to knowledge and the centrality of relationships for the full development of the individual personally and professionally, fosters our capacity to identify who we are both personally and professionally, connects reason and dialogue, and educates for dialogue and dialogic relationships.
Effective interprofessional collaboration depends upon establishing understanding that respects differences in values and beliefs, and thus differences in response to the multiplicity of patient/client/user needs. To facilitate the latter, this article suggests that health and social care students need a formal knowledge of the meaning of values and the varieties of systems within which values are expressed. Students need especially to understand the genesis of their own professional value system and to recognize the gap that inevitably develops between the values of the professional and those of the society within which a professional may function. The conceptual framework that underpins the approach to teaching values to health and social care professionals advocated here is derived from key concepts identified from the literature relating to education for, and participation in, a democratic, multicultural, multifaith society. These are: tolerance, compromise and education for dialogue. Finally, it is suggested that professional educators must take seriously the tasks of educating for professional pluralism.
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Over the last decade, nursing in the United Kingdom has witnessed a major development and expansion in the number of Clinical Nurse Specialists. These nurses are considered to be experts in their own specialities, have in-depth knowledge and provide a service for patients, relatives and staff. There is, however, a paucity of literature relating to role transition from experienced Staff Nurse to Clinical Nurse Specialist. Using Nicholson's (1984) model of work-role transition and Wanous' (1992) four-stage model of organizational socialization, this study explores the transition of two nurses from experienced Staff Nurses to novice Clinical Nurse Specialists.
The question of how to improve the quality of nursing care is quite properly perceived to be at the heart of the contemporary nursing debate. Yet it is not clear what quality in health care is; nor is it clear what quality nursing care is. This article will explore why quality issues are such a matter of concern in public and political debate and how different concepts of quality determine different definitions of nursing. The former definitions constitute a developmental continuum of nursing from minimally acceptable levels of competence to excellence. It is argued that the quality of nursing cannot be assessed in terms of performance referenced criteria, but only in terms of the personal qualities displayed in the performance. The key to improvement in practice may be the improvement of emotional and motivational tendencies. In essence, professional development implies personal development.
Quality of nursing cannot be assessed in terms of performance referenced criteria, but only in terms of the personal qualities displayed in the performance. The key to improvement in practice may be the improvement of emotional and motivational tendencies. In essence, professional development implies personal development. Harré makes a distinction between 'powers to do' and 'powers to be' (a state of being). The former are the capacities that individuals acquire to perform their tasks and roles. Professional development therefore involves, first, the acquisition of the capacities necessary for the successful completion of a set of professional tasks (the powers to do). Secondly, it involves the acquisition of the appropriate emotions and motivations, and the theories about human nature and the conduct that underpins them (the powers to be). Therefore, these capacities cannot be derived from analysis of tasks, since what are defined as tasks in the first place are determined by the exercise of such powers. The acquisition of attitudes constitutes a source of competent practice. Harré's model of 'personal identity' provides a conceptual framework for thinking about the process of the acquisition of nursing competence and its relationship to differing views of nursing. Considerations relating to different priorities within Harré's model make it possible to raise questions about the objectives of competence at different stages.
Diet is an important factor influencing the development of diabetes in the Biobreeding (BB) rat. Changes in gut development and absorption of nutrients in the diabetes-prone rat (Bbdp) and the subsequent effect on pancreatic function may play a role in the ultimate development of the disease. BBdp and normal (BBn) dams were fed one of three diets, chow or semipurified diets containing either soy or casein as the protein source. Pups were weaned at 21 d onto the same diet as their respective dam and killed at 30 d. Chow-fed BBn animals weighed significantly more than casein- or soy-fed BBn animals. Chow-fed BBdp had significantly greater small intestine and colon weight when expressed on a per body weight basis than BBn. With all three diets, BBdp animals had significantly lower colonic proglucagon mRNA abundance than did BBn animals. Adjusting for total colonic RNA content resulted in only casein- and soy-fed BBdp animals demonstrating significantly lower colonic proglucagon mRNA abundance than did BBn animals. BBn animals had higher levels of sodium-dependent D-glucose cotransporter (SGLT)-1 and sodium-independent glucose transporter (GLUT) 5 mRNA than did BBdp. Within BBn animals, casein and soy produced significantly lower levels of SGLT-1 and GLUT5 mRNA than did chow. This study demonstrates that BBn and BBdp animals respond differently to chow versus semipurified weaning diets. These differences may explain the differences in growth and intestinal development among the BBdp and BBn strains weaned onto different diets.
'Confidentiality' can become a somewhat embellishing signboard for paternalistic caring. In essence, one needs to distinguish between confidentiality as a respectful attitude to a patient/client, where it becomes credible that the caring professional will not misuse the information he or she obtains about the patient/client, and between confidentiality misused as an instrument of power to keep the patient/client outside of processes in which it might be important or advantageous for him or her to participate.
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Image directed localized 1H NMR spectra were obtained at 7 T (300 MHz) from cubic volumes of less than 40 microL in the gerbil brain. Signals from cerebral metabolites commonly detected in other rodent species were easily assigned, and high resolution spectroscopy (360 MHz) of aqueous brain extracts assisted the tentative identification of partially overlapping resonances from lower concentration compounds like alanine, lysine, gamma-aminobutyrate, valine, leucine and isoleucine. Weak coupling at 7 T was manifest in the resolution of signals from the gamma-CH2 groups of glutamine and glutamate. Down-field of water, signals assigned to purine nucleotides were conspicuous in the extract spectra, but localized spectra acquired routinely in vivo, using selective excitation and gradient crushing (SUBMERGE) for water suppression, exhibited little or no signal from purines. When localized in vivo spectra were acquired without water suppression, however, or using a low power binomial excitation sequence rather than SUBMERGE, a broad signal appeared at the resonant frequency of purine aromatic protons. NMR experiments on the nucleotide adenosine 5'-monophosphate (AMP) in 90% glycerol/10% D2O solution demonstrated that pre-irradiation of the water signal even for less than 100 ms attenuated the nucleotide signal appreciably. This implies that the soft pulses required for selective excitation of water in sequences such as SUBMERGE induce spin-diffusion which eliminates or diminishes the signal from nucleotides in vivo.
We are witnessing the most significant changes in the nature of the relationship between nursing education and higher education. However, there has yet to be a more philosophical explanation of what it would mean for our aims and practices as nurse educators if we were to take seriously the notion of nursing education within the context of higher education. This paper analyses the role of the university and raises the questions: What should higher education mean today? What should higher education mean for nursing? In response to the former question it is suggested there cannot be a total distinction between the concept 'higher education' and the socio-political context. Higher education has to be realized in particular historical societies and there is likely to be much controversy over how this should be done. In response to the latter question it is suggested that to warrant the title nursing 'higher education' the process should promise a freeing of the mind but also beyond, to bring about a new level of self-empowerment in the individual student. In essence, it should contain an emancipatory element. It is the articulation of normative aspirations such as these, that is so strikingly absent from so much of the debate relating to nursing education merging with higher education. Nursing education must not however fall victim to 'academic drift' which has often been regarded as a distinctive and persistent feature of higher education. It might be proposed that student nurses who move from an educational to a practice setting are subjected to 'a competing paradigm of occupational vocationalism'.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper reports a retrospective study of a Senior Lecturer in Nursing Studies experience of supervising a student teacher who, as part of her teaching placement experience, utilised 'Critically Reflective Analysis of an Educational Event' as a means to assess her teaching in the practice setting. The Senior Lecturer and student nurse teacher used an external 'advisor' to facilitate their meta-reflection on the theoretical perspectives that informed the process in which they were engaged. The paper raises the following questions for consideration--What is the link between ability to reflect and quality of practice? Is it possible to utilise reflective tutorials as a means of assessing professional competence whilst at the same time encouraging personal and professional development? Is the ability to reflect on practice dependent on the context? Should we assume that all practitioners have the necessary skills to supervise students in practice and what preparation and support is needed? The paper demonstrates that by introducing 'Critically Reflective Analysis of an Education Event' into the student teachers' curriculum the role of both supervisor and student teacher was challenged and changed. The paper also demonstrates that reflective tutorials are not wholly a retrospective business. They are creative, or recreative of a teaching experience, as well as to some extent representing it. Finally, even if one cannot speak in Kuhnian parlance, of a conceptual revolution, it would seem legitimate to say, in Schon's terms, that the contextual frame in which professional problems are addressed has undergone significant change.
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