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Clinical exemplars to recognize excellence in nursing practice.

Nursing is a dynamic, challenging, rewarding profession. It is important that we take opportunities to tell the world and each other about the richness of caring, which is the essence of our practice. Clinical exemplars are a way to capture this true nature of nursing. It is through sharing of clinical exemplars that we celebrate our own practice and share our uniqueness with others. This article defines clinical exemplars, describes their importance to nursing practice, and discusses their benefit to identify skill acquisition and recognition in nursing.

Autobiographies as Topic↗
PubMed1986

Personal documents and nursing theory development.

Personal documents, notably autobiographical accounts, supply a compelling realm of phenomenological data for nursing theory, providing insight and understanding into the nonnormative nature of health and health-related experience. Personal documents occasion a discussion of empathic understanding as an analytical component of human science and illness as an occasion of heightened personal awareness. Triangulation research strategies are advocated as a means of incorporating personal experience data in nursing research.

Aged↗
PubMed2000

Electroconvulsive therapy and memory loss: a personal journey.

The cause for the significant gap between research and anecdotal evidence regarding the extent of some memory loss after electroconvulsive therapy (ECT) has never been adequately explained. A patient's development of awareness and self-education about her severe side effects from ECT raises questions regarding many current assumptions about memory loss. ECT-specific studies, which conclude that side effects are short term and narrow in scope, have serious limitations, including the fact that they do not take into account broader scientific knowledge about memory function. Because of the potential for devastating and permanent memory loss with ECT, informed consent needs significant enhancement until advancing research on both improved techniques and on better predictive knowledge regarding memory loss progresses to making a greater impact on clinical applications. Follow-up care and education in coping skills need to be a regular part of ECT practice when patients do experience severe effects.

Adaptation, Psychological↗
PubMed2006

Medical school admissions: enhancing the reliability and validity of an autobiographical screening tool.

BACKGROUND: Most medical school applicants are screened out preinterview. Some cognitive scores available preinterview and some noncognitive scores available at interview demonstrate reasonable reliability and predictive validity. A reliable preinterview noncognitive measure would relax dependence upon screening based entirely on cognitive tendencies. METHOD: In 2005, applicants interviewing at McMaster University's Michael G. DeGroote School of Medicine completed an offsite, noninvigilated, Autobiographical Submission (ABS) preinterview and another onsite, invigilated, ABS at interview. Traditional and new ABS scoring methods were compared, with raters either evaluating all ABS questions for each candidate in turn (vertical scoring-traditional method) or evaluating all candidates for each question in turn (horizontal scoring-new method). RESULTS: The new scoring method revealed lower internal consistency and higher interrater reliability relative to the traditional method. More importantly, the new scoring method correlated better with the Multiple Mini-Interview (MMI) relative to the traditional method. CONCLUSIONS: The new ABS scoring method revealed greater interrater reliability and predictive capacity, thus increasing its potential as a screen for noncognitive characteristics.

Autobiographies as Topic↗
PubMed2005

Computerized content analysis of writings of Mahatma Gandhi.

Three brief excerpts from the autobiographical writings of Mohandas K. Gandhi were analyzed for neuropsychobiological content using the PCAD 2000 computer program. The computer software produces scores on 13 scales such as anxiety, hostility, cognitive impairment, and depression; compares the assigned scores with norms derived from 5-minute speech samples taken from normal, medically and psychiatrically healthy adults and children; and suggests DSM-IV diagnostic categories for consideration. The results demonstrate an objective, repeatable method for achieving insight into the mental states and traits of historic figures based on their writings.

Adult↗
PubMed2003

The early years of molecular biology: personal recollections.

The early years of molecular biology were characterized by a strong interaction between theory and experiment. This included the elucidation of the structure of DNA itself; genetic fine structure, recombination and repair; DNA replication; template-directed protein synthesis; the universality of the triplet genetic code, and the co-linearity of the DNA sequence of structural genes and the sequence of amino acids in proteins. The principle of co-linearity was later modified when split genes were discovered. It is suggested that accurate splicing of gene transcripts might also be template directed. In 1958 Crick proposed a 'central dogma' of molecular biology stating that information could not be transmitted from proteins to DNA. Nevertheless, proteins can chemically modify DNA, and this is now known to have strong effects on gene expression.

Autobiographies as Topic↗
PubMed2001

Sensory-perceptual episodic memory and its context: autobiographical memory.

Episodic memory is reconceived as a memory system that retains highly detailed sensory perceptual knowledge of recent experience over retention intervals measured in minutes and hours. Episodic knowledge has yet to be integrated with the autobiographical memory knowledge base and so takes as its context or referent the immediate past of the experiencing self (or the 'I'). When recalled it can be accessed independently of content and is recollectively experienced. Autobiographical memory, in contrast, retains knowledge over retention intervals measured in weeks, months, years, decades and across the life span. Autobiographical knowledge represents the experienced self (or the 'me'), is always accessed by its content and, when accessed, does not necessarily give rise to recollective experience. Instead, recollective experience occurs when autobiographical knowledge retains access to associated episodic memories. In this reworking of the 'episodic memory' concept autobiographical memory provides the instantiating context for sensory-perceptual episodic memory.

Autobiographies as Topic↗
PubMed2001

Neuroimaging studies of autobiographical event memory.

Commonalities and differences in findings across neuroimaging studies of autobiographical event memory are reviewed. In general terms, the overall pattern across studies is of medial and left-lateralized activations associated with retrieval of autobiographical event memories. It seems that the medial frontal cortex and left hippocampus in particular are responsive to such memories. However, there are also inconsistencies across studies, for example in the activation of the hippocampus and dorsolateral prefrontal cortex. It is likely that methodological differences between studies contribute to the disparate findings. Quantifying and assessing autobiographical event memories presents a challenge in many domains, including neuroimaging. Methodological factors that may be pertinent to the interpretation of the neuroimaging data and the design of future experiments are discussed. Consideration is also given to aspects of memory that functional neuroimaging might be uniquely disposed to examine. These include assessing the functionality of damaged tissue in patients and the estimation of inter-regional communication (effective connectivity) between relevant brain regions.

Autobiographies as Topic↗
PubMed2001

Experience of the Self in a lifetime.

While listening to a concert at the age of 20, I suddenly was overcome by a feeling of oneness. The music had touched deeper levels of my soul, which much later I could understand as an experience of the Self. Music may arouse opposite feelings, the source of which is the ambivalence of the Self, of God. These opposites within the Godhead are best explained by the word numinosity, a term coined by Rudolf Otto in his book The Idea of the Holy. Love and fear are opposite feelings with regard to God, to the 'numen'. A meaningful change in my life occurred at the age of 38 when my wife and myself decided to leave Switzerland and immigrate to Israel. Several dreams pointed to the necessity of settling in the Biblical Land, the earth being a manifestation of the mother archetype. The Jungian term Self is discussed by examples from my own analysis and by quoting Edinger. The Self is the mystery of conjunction of feminine and masculine energy. This was clear to me, but what about the evil, dark side of God, of his destructive side, of Satan or the devil, of Christ and Antichrist? I experienced the dark side of God when the Nazis rose to power, unleashing WW II and killing 6 million Jews in the Holocaust.

Autobiographies as Topic↗
PubMed2003

On defining words, some scenarios and vectors in the 'autobiography' of C. G. Jung.

Having first considered recent research into the circumstances surrounding the production and publication of the 'autobiography' of Jung, the author concludes that in spite of its being the work of several authors, it nevertheless constitutes a whole. Taken from whichever angle, they all point to Jung's particular inquiry into the unconscious, as it emerges through Jung's own words. The author goes on to suggest both a lateral and a structural reading of MDR (Memories, Dreams, Reflections) which in turn reveals, on the basis of the several dreams reported, the central 'fantasy' which inspired Jung's research and his oeuvre. Finally, he discusses the idea of the collective or impersonal unconscious and highlights the emphasis Jung places on processes which unfold according to rhythms which are associated with distinct scales, depending on whether they are those of the individual, the clan or the culture.

Austria↗
PubMed2001

Motive-related memories: content, structure, and affect.

Two studies tested hypotheses on the content and structure of autobiographical memories and the affect linked to them. In Study 1, agentic- and communal-motivated individuals recorded their most memorable experiences and completed the PANAS each day for 6 weeks. Memories were coded for content and structure. Agentics and communals reported more motive congruent memories, and their congruent memories were structured using more differentiation and integration, respectively. In addition, agentics had slightly higher PA and lower NA scores. In Study 2, agentics and communals recalled an event pertaining to either social separation or connection and then completed an affect measure of agentic and communal items. Agentics recalled more agentic memories in the separation condition and communals recalled more communal memories in the connection condition. Complexity analyses showed that agentics and communals used differentiation and integration respectively to recall their motive-congruent memories. The affect data showed a modestpredicted pattern. Results suggest that implicit motives have an impact on autobiographical memory but are not as clearly related to self-report affect measures, possibly due to method variance.

Affect↗
PubMed2003

Obstructive sleep apnea syndrome: autobiographical memory predicts the course of depressive affect after nCPAP therapy.

Although nCPAP therapy has proven to be efficient at removing symptoms of obstructive sleep apnea syndrome (OSAS), recovery from depression frequently remains unsatisfactory. Other studies have shown that recall of autobiographical memories (AM) is a psychological vulnerability marker for depression, and also have shown its predictive power for the course of depression. It is therefore hypothesized that AM also predict the course of depressive affect in OSAS patients. Fifty-four consecutively admitted OSAS patients received standard nCPAP therapy. Specificity of AM assessed at the beginning of treatment was used as a predictor in a regression analysis, and the extent of recovery from depression over a follow-up period of between six to nine weeks served as the criterion variable. The results supported the hypothesis that patients who were able to recall more specific AM in response to positively valenced cue words showed a more substantial recovery from depression. This has important treatment implications.

Autobiographies as Topic↗
PubMed2005

Sex, shame and the transcendent function: the function of fantasy in self development.

This paper explores a developmental approach to the sense of self-agency and to its influence on conscious and unconscious fantasy. I suggest that the emerging sense of self-agency offers an over-arching framework for our understanding of the nature and function of fantasy. In this context, intrusive and compulsive sexual fantasies which a person experiences as perverted and shameful, can be seen to serve differing psychic purposes, depending on the level of self-agency which is predominant. The fantasies can serve both as warning signals of the dangers of relationship and as opportunities for the mind to reflect on its own processes. Differing psychodynamic theories of fantasy are examined in terms of the developmental sense of self-agency that they represent.

Autobiographies as Topic↗