Alternatives to the face-to-face interview for collecting gerontological needs assessment data.
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Medical schools have been slow to include meaningful end-of-life (EOL) educational experiences in their curricula. As an area of inquiry and focused clinical experience, death is "conspicuous" by its absence, reflecting a medical culture that defines death as failure. The author asked fourth-year medical students at one institution to describe their experiences with dying patients and their families, the skills and attitudes they brought to these encounters, the support they received from attendings and residents while caring for dying patients, and suggestions for the medical curriculum that would help prepare them for care of the dying. Using a qualitative method, she analyzed ten students' written narratives, which dealt with experiences during their third-year clerkships, and compared these reflections with the literature on EOL care in medical education. The themes that emerged provided four organizers for this essay: (1) students' worry and uncertainty about EOL care, (2) guidance and role modeling in EOL care, (3) preparation for EOL care, and (4) conclusions and recommendations for the medical curriculum. In general, students did not feel well prepared or supported as they cared for their first dying patients, including, for example, delivering a terminal prognosis or obtaining a DNR. However, while they did wish for more support and role modeling from residents and attendings, they generally believed that care of the dying can be learned only through direct clinical experience. These beliefs call into question curricular issues of placement of EOL inquiry--most often in the preclinical curriculum--and the teaching of its content, currently overwhelmingly by lectures. The author concludes with recommendations for thoughtful, integrative, interdisciplinary curriculum changes in EOL education.
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AIMS: To assess audio computer-assisted self-interviewing (A-CASI) as a mode of data collection with injecting drug users (IDUs) entering two drug treatment programs in New York City. A-CASI has been found to increase reporting of sensitive items among a variety of population subgroups. DESIGN: A field test of A-CASI data collection conducted within an ongoing cross-sectional study of drug use and HIV risk behaviors among IDUs entering drug treatment. Participants were assigned without bias to either a computer-assisted interviewer-administered personal interview (CAPI) or to a mixed CAPI/A-CASI interview. In the latter, 'sensitive' portions (dealing with stigmatized behavior) of the questionnaire were self-administered through A-CASI, while the remaining portions were interviewer-administered. SETTING: The Detoxification Program and the Methadone Maintenance Treatment Program (MMTP) at Beth Israel Medical Center in New York City. PARTICIPANTS: Seven hundred and eighty-three IDUs entering drug treatment. MEASUREMENTS: Odds ratios and adjusted odds ratios (controlling for demographic differences) for comparison of A-CASI versus CAPI responses on 111 sensitive questions. FINDINGS: Twenty-three statistically significant differences (each at P < 0.05), all in the direction of more reporting of the behaviors by the A-CASI group. Forty-one per cent of A-CASI participants said they would prefer any subsequent interviews to be fully A-CASI and 46% said they would prefer the mixed CAPI/A-CASI mode. CONCLUSIONS: A-CASI was associated with greater reporting of potentially stigmatized drug, sex and HIV risk behaviors on a moderate number of questions. Moreover, a large majority of participants who used A-CASI would like to be assigned to this method of data collection in future interviews.
Executive nurse managers, as well as other nurse managers, spend much time responding verbally to people. Whether or not their responses are effective in these situations remains an unexplored area in nursing administration. The author describes a research-based framework to analyse managerial actions. Five types of actions, three non-exploratory and two exploratory, were identified through previous research using Orlando's theory as the framework. Subsequent research suggests nurses prefer that their managers use exploratory action. The article contains discussion on how specific types of actions facilitate or thwart problem identification.
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Under light excitation transmembrane electron transfer is observed when a stacked Zn-Cu-Zn triporphyrin is incorporated in a bilayer between aqueous redox phases. The electric polarization of the membrane due to the photoinduced transmembrane charge flux drives ion transport. This effect increases the net charge transfer across the system, giving rise to an amplification similar to a field effect transistor. Thus this system can be considered an organic phototransistor.
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