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PubMed1999

Characterizing knowledge deficits in phonological disorders.

To aid the development of finer-grained measures of phonological competence within a representation-based approach to phonology, two aspects of nonsymbolic phonological knowledge (knowledge of the acoustic/perceptual space and of the articulatory/production space) were examined in 6 preschool-age children with phonological disorders and 6 typically developing age peers. To evaluate perceptual knowledge, gating and noise-center tasks were used. Children with phonological disorders recognized significantly fewer words than age peers on both tasks. To evaluate production knowledge, spectral and temporal measures were obtained for CV sequences involving both lingual and labial stop consonants. Group differences on this task (such as larger transition slope values from lingual consonants to vowels for children with phonological disorders) were also observed. These differerences were interpreted as indicating that the children with phonological disorders were less able to maneuver jaw and tongue body separately or that they used "ballistic" (i.e., less controlled) gestures from lingual consonants to vowels than their age peers. These results suggest that phonological knowledge is multifaceted, and that seemingly categorical deficits at one level can be linked to less robust representations at other levels.

Articulation Disorders↗

PubMed2001

The knowledge and attitudes of surgical staff towards the use of opioids in cancer pain management: can the Hospital Palliative Care Team make a difference?

The principles of cancer pain management are well established, but evidence suggests that these are not incorporated into daily practice and patients are still in pain. Deficiencies in knowledge and inappropriate attitudes towards the use of opioids may partially explain why the management of cancer pain is still such a widespread problem. This study assessed the knowledge and attitudes of 135 nursing and medical staff working in a surgical unit, before and after working with a newly established Hospital Palliative Care Team. The baseline survey highlighted the existence of a number of myths and misconceptions in relation to opioid use. Results of the follow-up survey indicated that the knowledge and attitudes of doctors and nurses had improved after working with the team, but that this probably occurred as a result of good working relationships and case discussions rather than through formal teaching. The study provided a useful method of identifying deficiencies in knowledge and attitude among staff, and helped to raise awareness of the problem of cancer pain management. Our challenge now is to work with staff to ensure that positive changes in knowledge and attitudes are translated into the everyday practice of hospital nurses and doctors caring for patients with cancer.

Adult↗

PubMed1999

General practitioners' knowledge of functional and social factors in patients with rheumatoid arthritis.

The care of people with chronic physical disease is an important part of the work of general practitioners (GPs). Knowledge of social and functional factors, and good teamwork with other health and social care professionals, are necessary to provide high quality general practice care. This study investigated functional disability, social situation and the involvement of health and social care professionals in patients with rheumatoid arthritis, and their GPs' knowledge of these factors. Questionnaires were sent to all patients aged 15-74 with rheumatoid arthritis in two general practices, and similar questionnaires were given to their GPs. Functional disability was assessed using the health assessment questionnaire (HAQ), on a scale of 0-3. The GP consultation rate for patients with rheumatoid arthritis in the previous year was 6.9 compared to 3.7 for all patients in the practices, and increased with increasing disability. Sixty-five per cent of patients had a moderate (HAQ > 1 but </= 2) or severe (HAQ > 2) disabiltiy. There was an average difference between patient and GP scores for functional disability on the HAQ of 0.49 (95% confidence interval 0.36-0.62), with GPs scoring lower than patients and the difference increased with increasing disability. Seventy-one per cent of patients had seen a rheumatologist or orthopaedic surgeon in the previous year, but there was little involvement by other members of the primary health care team (PHCT). General practitioners had good levels of knowledge of their patients' employment status and who they lived with, but poor knowledge of most of the welfare benefits they were receiving, and of other health and social care professionals involved. It is concluded that GPs see their patients with rheumatoid arthritis frequently, but are often lacking the knowledge about their patients to provide high quality care. They often only know about aspects of their patients' care in which they are directly involved. Ways are suggested for how this situation could be improved.

Journal Article↗

PubMed1993

The knowledge base of health visitors and district nurses regarding products in the proposed formulary for nurse prescription.

The background to the legalization of nurse prescribing is reviewed and a small questionnaire survey of health visitors and district nurses described. Significantly more district nurses than health visitors wanted to become nurse prescribers. Health visitor knowledge of some parasiticidal lotions and antifungal agents was found to be variable and the recommended dose of paracetamol for post-immunization pyrexia was recognized by less than two-thirds of the sample. District nurse knowledge of lactulose was limited in comparison to their knowledge of alginate and hydrocolloid dressings; however, their knowledge of factors other than dressing type which enhance or delay healing was variable. The mean knowledge scores of both the health visitors and district nurses were unacceptably low for prescribing purposes. The majority of the total sample stated that they would like further training, with a preference for such provision in the form of study days.

Clinical Competence↗

PubMed1993

Nurses' knowledge and opinions about the nursing research process in The Netherlands.

Nursing research is just gaining ground in The Netherlands, as it is in every European country. Therefore, this study had the purpose of discovering to what extent Dutch nurses in the clinical areas have acquired research-based knowledge since it was introduced into the country, in the 1970s. Questionnaires, which included provision for demographic data, were distributed to 110 nurses, comprising head nurses, recently qualified nurses and final-year student nurses. A 65% response was achieved and the findings revealed that nursing research as a concept was not new to the Dutch nurses. They claimed they had obtained their knowledge through nursing training, reading, conferences and other sources such as mass media. The head nurses were the most knowledgeable followed by the recently qualified nurses and then the student nurses. However, the respondents claimed that their knowledge was superficial. The need to extend nurses' knowledge through support and encouragement in relation to nursing research seminars and conferences is recommended.

Adult↗

PubMed2004

Influence of a multidisciplinary paediatric allergy clinic on parental knowledge and rate of subsequent allergic reactions.

BACKGROUND: Studies have demonstrated that families of children with food allergy have significant deficiencies in their knowledge of how to avoid allergen exposure and how to manage allergic reactions. This study aims to assess the impact of a multidisciplinary paediatric allergy clinic consultation on parental knowledge of food allergy and to determine the rate of subsequent allergic reactions. METHODS: Sixty-two subjects (<17 years) referred with food allergy were prospectively enrolled. Parental knowledge was assessed by questionnaire and EpiPen trainer. Families saw a paediatric allergist, clinical nurse specialist and dietician. Knowledge was reassessed after 3 months and rate of allergic reactions after 1 year. RESULTS: After one visit to the paediatric allergy clinic, there was a significant improvement in parental knowledge of allergen avoidance (26.9%, P < 0.001), managing allergic reactions (185.4%, P < 0.0001) and EpiPen usage (83.3%, P < 0.001). Additionally, there was a significant reduction in allergic reactions (P < 0.001). Children with egg, milk or multiple food allergies were more likely to suffer subsequent reactions. CONCLUSIONS: A single visit to a multidisciplinary allergy clinic considerably improves families' abilities to manage allergic reactions to foods with an accompanying reduction in allergic reactions. Young children with egg, milk or multiple food allergies were at greatest risk of further reactions.

Adolescent↗

PubMed2003

Role of knowledge and ability in student nurses' clinical decision-making.

Little is known about the acquisition of decision-making skills in nursing students as a function of experience and academic ability. Knowing how experience and academic skills interact may help inform clinical education programs and formulate ways of assessing students' progress. The aims of the present study were to develop a problem-solving task capable of measuring clinical decision-making skills in novice nurses at different levels of domain-specific knowledge; and to establish the relative impact on decision-making of domain-specific knowledge and general ability as determinants of the acquisition of decision-making skills. Three types of clinical problems of increasing complexity were developed. Sixty second-year and third-year student nurses with high and low academic scores were studied in terms of their ability to generate hypotheses for a hypothetical case, recognize disconfirming information and the need to access additional information, and diagnostic accuracy. The results showed that general academic ability and knowledge function partly independently in the acquisition of expertise in nursing. Academic ability affects decision-making in low complexity tasks, but as case complexity increases, domain-specific knowledge and experience determines decision-making skills. There are important differences in the way novices with different levels of knowledge and ability make clinical decisions and these can be studied by systematically increasing the complexity of the decision task. These results have implications for the way in which clinical education is structured and evaluated.

Clinical Competence↗

PubMed2003

Knowledge of female bladder care among medical staff, nurses and midwives: results of a questionnaire survey.

OBJECTIVE: To determine knowledge about bladder care among junior medical staff and allied health professionals, and to examine any difference in knowledge among the subgroups. SUBJECTS AND METHODS: Using a single-questionnaire survey in a large obstetrics and gynaecology Hospital Trust in an inner city setting, midwives, nurses and medical staff (not consultants) were asked eight questions about different aspects of female bladder physiology and care. The differences in responses among the professional groups were assessed. RESULTS: In all, 120 completed questionnaires were returned (32 doctors, 40 nurses, and 48 midwives). Knowledge was similar on urethral length, bladder capacity, daily fluid intake, ideal size of catheter, catheter balloon size, and the maximum time of use of a short-term catheter. Correct responses for normal daily fluid intake, duration of both short and long-term catheterization were given by fewer than half the respondents. There were significant differences among the professional groups in the correct response rate for long-term catheter duration (P = 0.031) and the normal time interval between voids (P = 0.038). CONCLUSION: There were significant differences in the knowledge of all subgroups about bladder care, and poor levels of knowledge in several areas. This is a potentially serious problem for women at risk of bladder complications after gynaecological surgery and childbirth. All staff involved in managing women after childbirth and gynaecological surgery should have formal training in bladder care, to optimize patient care.

Clinical Competence↗

PubMed2001

Nurses' knowledge and attitudes towards cancer-related fatigue.

Fatigue is the most common symptom associated with cancer and cancer treatment and is now widely recognized as a significant problem for patients with cancer (Ream & Richardson 1999). Although the profile of cancer-related fatigue has grown over the past few years within the specialty of oncology, not all patients with cancer receive care from cancer specialists. As a result of restructuring of cancer services, the majority of patients within the UK receive their cancer treatment outwith a cancer centre and are supported by District General Hospitals and community-based services. Consequently, it is appropriate to evaluate nurses' fatigue knowledge and attitudes across a range of clinical settings caring for patients with cancer. Nurses were recruited from community, general medical, general surgical and oncology clinical settings (n=470). A postal questionnaire to evaluate fatigue knowledge and attitudes was administered. A response rate of 43% was achieved. Data were analysed descriptively. Underestimation of fatigue incidence (by 28% of respondents), poor knowledge and practice regarding fatigue assessment and management, and poor fatigue communication practices were common throughout all clinical areas. However, nurses from all settings consistently demonstrated a good understanding of the impact of fatigue on patients with cancer and an appreciation of the importance of the role of the nurse in fatigue management. While oncology nurses demonstrated the greatest fatigue knowledge, these were not significantly better than the other specialties. A significant proportion of nurses caring for patients with cancer are unaware of fatigue's incidence, assessment and management. As cancer incidence rates are set to rise and the spectrum of clinical settings in which patients receive their care is increasing, it is imperative that this common and debilitating symptom receives appropriate recognition from health-care professionals. A number of strategies to enhance knowledge and information dissemination should be initiated to ensure that patient outcomes in relation to cancer-related fatigue are improved.

Journal Article↗

PubMed2003

The views of district nurses on their level of knowledge about the treatment of leg and foot ulcers.

OBJECTIVE: The aim was to survey the views of a sample of district nurses on their own level of knowledge about the treatment of leg and foot ulcers and what they considered to be the most important issues in wound treatment. DESIGN: A descriptive design was used. SETTING AND SUBJECTS: The subjects were all the nurses who treated leg and foot ulcers in the community health care service in Oslo, Norway, during autumn 1999. The subjects were selected after consultation with senior nurses. INSTRUMENTS: A structured questionnaire with blank spaces for in-depth comments was used. METHODS: The head of the nursing service in all 25 urban districts received a letter about the study with a questionnaire that they passed on to the nurses treating ulcers. Out of 173 eligible nurses, 102 (59%) filled in the questionnaires. Descriptive and interpretative analyses were then made. RESULTS: Most of the participating nurses (60%) believed that their knowledge of wound treatment was insufficient. A high degree of uncertainty related to wound treatment situations was also found. The uncertainty included wound treatment, wound assessment, wound healing products, and wound causes. The main sources of the nurses' knowledge were their own nursing practice and colleagues. Twenty different factors of importance in wound treatment were reported. The most frequently mentioned factors were: wound healing, continuity in the treatment process, alleviation of pain, hygiene, compression therapy, and diagnosis. The lowest scores were awarded to documentation and economic factors. CONCLUSIONS: The nurses perceived their knowledge of leg and foot ulcer treatment to be insufficient. Their own nursing practice and colleagues were their main sources of knowledge.

Adult↗

PubMedDate not supplied

Evaluating health and safety knowledge of preschoolers: assessing their early start to being health smart.

INTRODUCTION: The purpose of this study was to establish the validity, reliability, and utilization of a revised and expanded Preschool Health and Safety Knowledge Assessment (PHASKA), an instrument evaluating health and safety knowledge of young children, on a diverse group of preschool children. METHODS: This study included 308 children (133 boys and 175 girls) ranging in age from 28 to 80 months (M = 53.7 months). The PHASKA was administered to children at 6 preschools and 5 health fairs on an individual basis. RESULTS: Scores on the PHASKA ranged from 1 to 49 (out of a possible 50 points), with a mean score of 37.25. Ninety-seven percent of the children older than age 3 years completed the assessment. No significant differences attributable to gender were found. However, significant age group differences were found [F (7,300) = 31.09, P < .0001]. In general, items related to safety were learned first, followed by those related to hygiene, health promotion, and nutrition. DISCUSSION: Preschoolers' scores on the PHASKA showed significant improvement with age, supporting the assertion that preschoolers are ready and willing learners of health and safety knowledge. Children rapidly gain health and safety knowledge between 3 1/2 and 5 1/2 years of age and master much of this content by their sixth birthday. The PHASKA was shown to be appropriate for determining health and safety knowledge scores for preschool-aged children.

Accident Prevention↗

PubMed1998

Genetic links, family ties, and social bonds: rights and responsibilities in the face of genetic knowledge.

Currently, some of the most significant moral issues involving genetic links relate to genetic knowledge. In this paper, instead of looking at the frequently addressed issues of responsibilities professionals or institutions have to individuals, I take up the question of what responsibilities individuals have to one another with respect to genetic knowledge. I address the questions of whether individuals have a moral right to pursue their own goals without contributing to society's knowledge of population genetics, without adding to their family's knowledge of its genetic history, and without discovering genetic information about themselves and their offspring. These questions lead to an examination of the presumed right to genetic ignorance and an exploration of a variety of social bonds. Analyzing cases in light of these considerations leads to a surprising conclusion about a widely accepted precept of genetic counseling, to some ethical insights into typical problems, and to some further unanswered questions about personal responsibility in the face of genetic knowledge.

Beneficence↗

PubMed2002

A questionnaire assessment of nutrition knowledge--validity and reliability issues.

OBJECTIVE: This study describes an evaluation of validity and reliability measures in a questionnaire designed to assess knowledge of applied nutrition in children participating in an after-school care dietary intervention programme being undertaken in an area of high social disadvantage. DESIGN: Three domains were assessed: Knowledge of Applied Nutrition (KN), Knowledge of Food Preparation (KP) and Perceived Confidence in Cooking Skills (PC). Four pilot studies were undertaken to determine item reliability, test-retest reliability, discrimination and difficulty indices, and content, cognitive and face validity. SETTING: Primary schools in Dundee, Scotland and Newcastle upon Tyne, England. SUBJECTS: Ninety-eight children aged 11 years. RESULTS: The final instrument comprised 36 questions (18 KN items, 9 KP items and 9 PC items) presented on four sides of paper, which could be self-completed in less than 15 minutes. Question formatting included open and closed structures (KP) and multiple choice (KN and PC) items. All knowledge questions could be answered correctly by 5 to 95% of the target population, with discrimination scores ranging from 0.06 to 0.83. Retest reliability scores were significant (KN 0.458, KP 0.577, PC 0.381, ) and internal reliability (Cronbach's alpha) of each component was also significant. CONCLUSION: The test meets basic psychometric criteria for reliability and validity and forms a suitable instrument for measuring changes associated with intervention work aimed at improving food and dietary knowledge.

Child↗

PubMed1997

Preschool children's use of information about age and perceptual access to infer another person's knowledge.

Preschool children's use of information about age and perceptual experience to infer other people's knowledge was investigated. Because young children may view adults as omniscient, the hypothesis that 3-year-olds regard an observer's age and perceptual experience as equally important when inferring the observer's knowledge was tested. In Experiment 1, 3- and 4-year-olds were asked to judge which of 2 observers, 1 adult and 1 same-age child, knew the identity of a hidden object. On some trials, the adult looked at the hidden object; on other trials, the same-age peer looked at the hidden object. The children who were 3.5 years old relied on information about perceptual experience when judging knowledge. However, the younger 3-year-olds often chose the peer, even though the adult was knowledgeable. The children may have chosen the peer on the basis of familiarity; therefore, adult and child dolls were used in Experiment 2. Neither the 3-year-olds nor the 4-year-olds attributed knowledge on the basis of age rather than perceptual experience.

Adult↗

PubMed2004

Clinical teachers' tacit knowledge of basic pedagogic principles.

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness.

Delphi Technique↗

PubMed2006

Greater knowledge gain with structured than student-directed learning in Child Health: cluster randomized trial.

The aim of this study was to detect a difference in knowledge gain between students receiving structured versus student-directed learning for the two-week Child Health outpatient module. A total of 138 phase 3 (year 4) medical students in 10 two-week paediatric outpatient blocks at the Department of Child Health, University of Dundee, Scotland, were randomized to student-directed or structured learning between January and December 2002. Pre- and post-course tests were administered at the start and the end of the attachment; 129 students sat both tests. Results are presented as mean scores with standard deviations or 95% confidence intervals (CI) in parentheses. The primary outcome measure was gain in knowledge of the Child Health core curriculum that is covered in the outpatient setting. Although pre-course scores were similar (student-directed 25.3 (7.3); structured 24.8 (7.5)) the structured approach resulted in higher post-course scores in comparison with the student-directed approach (student-directed 41.8 (9.4); structured 53.8 (8.8); p < 0.01). Knowledge gain showed significant differences between the two learning approaches (student-directed 16.5 (3.7); structured 29.1 (3.8), difference = 12.6 (95% CI 11.3 to 13.9)). Low pre-course scores or gender did not affect knowledge gain. In the Child Health outpatient setting, the 'traditional' structured approach led to significantly greater knowledge gain in comparison with the 'novel' student-directed approach. The findings emphasize the importance of careful evaluation of novel medical education strategies before their implementation in medical schools, and the need for further research to define the effective methods for delivering medical education in Child Health.

Child↗

PubMed1994

Teaching within a curricular zone of safety: school culture and the situated nature of student teachers' pedagogical content knowledge.

The purpose of this paper is to continue the theoretical delineation of the nature of pedagogical content knowledge. Two student teachers were observed teaching an elementary games and high school sport unit and interviewed in depth about their lessons, biography, pedagogical content knowledge, and aspects of the school culture. Data were analyzed by constant comparison and analytic induction. Trustworthiness was established through member checks and triangulation. In the high school, both student teachers tried to use extending and refining tasks, as they had in the elementary school. But, when confronted with aspects of the high school culture, both retreated to a curricular zone of safety relying on application tasks. This zone, the defining aspect of their pedagogical content knowledge of teaching sports, emerged from and was constituted by the relations among goals, capabilities, teaching, inadequate pedagogical content knowledge, and aspects of the school culture. It is argued that situated and cultural orientations contribute to psychological orientations currently used to delineate pedagogical content knowledge. A curricular zone of safety is offered as a concept that helped account for the emergence and persistence of particular ways of knowing content.

Adult↗

PubMed1996

Knowledge representation and problem solution in expert and novice youth baseball players.

The purpose of this study was to examine differences in knowledge representation and problem solutions in expert and novice youth baseball players. Ninety-four players in two age divisions, 7-8 years of age and 9-10 years of age, were assigned to three levels of expertise: high; average; and low skilled. Each subject participated in an interview session to elicit knowledge representation and solutions to five different defensive game situations. Interviews were transcribed and analyzed for content, solution to the problem, errors in problem solution, and qualitative trends. The frequency of advanced solutions to each of the five situations were analyzed in separate chi-square tests for age and expertise. Differences among the levels of expertise were found for the accuracy of solutions to three complex situations. Age was significant for only one situation. Patterns of knowledge content accessed during advanced and less advanced responses indicated both experts and novices were in a beginning stage of developing baseball knowledge structures. Errors in problem solutions indicated children had difficulty monitoring critical conditions and making correct inferences. Players' and teammates' ability to execute baseball skills seemed to influence the content and structure of tactical knowledge accessed during problem solution.

Age Factors↗

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