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PubMed2001

Testing a causal model for learning in a problem-based curriculum.

The aim of this study was to identify the relationship between elements that are important for the tutorial group process and the individual learning process in a problem-based curriculum. The variables under investigation were student-generated learning issues, individual learning process, reporting in the tutorial group, and achievement.A questionnaire containing 22 items was developed. Data were collected in the first year (N = 195) of the Medical School of the Maastricht University in the Netherlands during the academic year 1997-1998. The data were analysed using a structural modelling approach. The results indicate that the model fitted the data well. The path coefficients were moderately high, particular between the explanation-oriented approach and the depth of the reporting in the tutorial group. High path coefficients were also found between the depth of the reporting and achievement. In sum, the model gives insight into how important variables are related and it is recommended that data should be collected to test the model repeatedly.

Curriculum↗
PubMed2006

Peer-professional workgroups in palliative care: a strategy for advancing professional discourse and practice.

BACKGROUND: As part of a comprehensive national effort to improve care at the end of life, the Promoting Excellence in End-of-Life Care program of The Robert Wood Johnson Foundation convened "national peer-professional workgroups" of recognized authorities or leaders to advance palliative aspects of practice in their respective specialties or fields. OBJECTIVE: The conveners' goals were to establish research and practice agendas to integrate palliative care within selected fields and health care settings, and to expand delivery of palliative care to special patient populations that have been underserved by palliative care. We hypothesized that leading professionals within specific fields, chartered to achieve clear goals, and then provided with sufficient administrative and logistical support, could develop recommendations for expanding access to, quality of and financing for palliative care within their disciplines. DESIGN: Staff at the national program office of Promoting Excellence in End-of-Life Care convened eight disease-based, specialty-based or issue-based workgroups (the selected workgroup topics were amyotrophic lateral sclerosis, cost accounting, critical care, end-stage renal disease, human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS] disease, Huntington's disease, pediatric care, and surgical palliative care). The national program office implemented a small group process design in convening the groups, and provided coordination, oversight and administrative support, along with funds to support meetings (telephone and in-person). A workgroup "charter" guided groups in determining the scope of efforts and set specific, time-limited goals. From the outset, the workgroups developed plans for dissemination of workgroup recommendations to defined stakeholder audiences, including health care providers, policy-makers, payers, researchers, funders, educators, professional organizations and patient advocacy groups. SETTING AND SUBJECTS: Groups averaged 25 members and met for an average of 24 months. Promoting Excellence leadership chose workgroup topic areas that addressed patient populations underserved for palliative care, and corresponding professional specialties with demonstrated interest and readiness to improve education, evidence base, and professional expertise in palliative aspects of care. RESULTS: Each workgroup was highly productive and advanced changes in respective fields through developing and disseminating recommendations to their respective fields regarding practice, education, clinical and health service research and policy. Beyond their chartered responsibilities, workgroups also developed educational programs and curricula and a wide array of resources. The workgroups also authored articles for publication, intended to stimulate professional discourse and influence clinical norms and culture. CONCLUSIONS: The national peer-professional workgroup model exceeded original expectations and produced well-considered Recommendations to the Field as well as a body of resources for professionals in expanding access to and quality of palliative care. Results of this experimental venture in professional change suggest that the workgroup model may be a useful, cost-effective, rapid-change strategy for quality improvement in other areas of professional practice and service delivery.

Foundations↗
PubMed2004

Integrating education and research in an APRN mental health services program.

The Mental Health Services Program (MHSP), using an advanced practice psychiatric nursing model of care, was developed in an effort to address the need for community mental health services for an underserved population in Bridgeport, Connecticut. Under the direction of an Advanced Practice Psychiatric Nurse (APRN), direct services were provided by contracted APRNs and graduate and undergraduate nursing students, under the supervision of APRNs. Services provided included screenings for mental health problems; individual, family, and group education and counseling; psychiatric assessments; and consultations. More than 1,500 individuals, the majority of whom were vulnerable or at risk, were provided services during the 3 years of this grant-funded project. Client satisfaction was measured using the Goal Attainment Scale. Results indicated a high level of satisfaction and served as an indirect measure of effectiveness of services. More than 95% of respondents indicated that their goals were met "much better than expected." Furthermore, responses from community agency personnel indicate a high level of satisfaction with the services offered. As a result of the MHSP, curriculum changes have been implemented to integrate student community involvement and collaboration, and to facilitate student projects in the community. These curriculum changes include a health promotion project, a group process project, a mental health group project, and a research project. The students who participated as part of the MHSP benefited from their work in the real world with an underserved population in a way that otherwise would not have been possible. Services to the community will continue through the significant curriculum enhancement for mental health projects.

Adolescent↗
PubMed2005

In the Belly of the Beast: Traumatic Countertransference.

The authors discuss their work together in a consultation process. One author led many groups that were created to facilitate recovery for persons directly impacted by the terrorist attacks on September 11, 2001; the other acted as consultant to the therapist/leader. The leader was a resident of New York City at the time of the attacks; the consultant lived in a distant Midwestern city and the two had never met prior to the work. They describe their experience of working together and the role of this collaboration in the lives of the leader and the groups. Well aware that little exists in the literature about groups led by leaders having experienced the same trauma as group members, the authors pay special attention to the countertransference that each underwent and raise questions about the effects of that on the group process.

Journal Article↗
PubMed2005

In the belly of the beast: traumatic countertransference.

The authors discuss their work together in a consultation process. One author led many groups that were created to facilitate recovery for persons directly impacted by the terrorist attacks on September 11, 2001; the other acted as consultant to the therapist/leader. The leader was a resident of New York City at the time of the attacks; the consultant lived in a distant Midwestern city and the two had never met prior to the work. They describe their experience of working together and the role of this collaboration in the lives of the leader and the groups. Well aware that little exists in the literature about groups led by leaders having experienced the same trauma as group members, the authors pay special attention to the countertransference that each underwent and raise questions about the effects of that on the group process.

Countertransference↗
PubMed1990

Group psychotherapy--a route to personal insight.

Group psychotherapy aims to achieve personal insight and change by resolving problems through the group process. This article examines how group analysis works and explores the role of the group therapist.

Humans↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. Introduction--the different ways to reach consensus.

The many interrelated issues concerning administration of antibiotics following operations for abdominal contamination and infection were a powerful impetus to create this Discussion Forum in The European Journal of Surgery, which focuses on the duration of administration-a previously neglected topic. The guidelines presented herein are not based on previous randomised trials alone, nor are they prescribed by dictatorship of one person. Instead, they are proposed by a steering committee in the form of a table and are confirmed by consensus of many experts. The science of consensus has to be recognized in surgery. The Discussion Forum offers written judgements that provide more details than the usual Consensus Development Conference statements. It can be used for a nominal group process organized by sepsis trial groups and may be of value for a consensus-based treatment of individual patients.

Abdomen↗
PubMed2006

Improving the use of research evidence in guideline development: 2. Priority setting.

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the second of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on priority setting for health care guidelines, recommendations and technology assessments. METHODS: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: There is little empirical evidence to guide the choice of criteria and processes for establishing priorities, but there are broad similarities in the criteria that are used by various organisations and practical arguments for setting priorities explicitly rather than implicitly, WHAT CRITERIA SHOULD BE USED TO ESTABLISH PRIORITIES?: WHO has limited resources and capacity to develop recommendations. It should use these resources where it has the greatest chance of improving health, equity, and efficient use of healthcare resources. We suggest the following criteria for establishing priorities for developing recommendations based on WHO's aims and strategic advantages: Problems associated with a high burden of illness in low and middle-income countries, or new and emerging diseases. No existing recommendations of good quality. The feasibility of developing recommendations that will improve health outcomes, reduce inequities or reduce unnecessary costs if they are implemented. Implementation is feasible, will not exhaustively use available resources, and barriers to change are not likely to be so high that they cannot be overcome. Additional priorities for WHO include interventions that will likely require system changes and interventions where there might be a conflict in choices between individual and societal perspectives. WHAT PROCESSES SHOULD BE USED TO AGREE ON PRIORITIES?: The allocation of resources to the development of recommendations should be part of the routine budgeting process rather than a separate exercise. Criteria for establishing priorities should be applied using a systematic and transparent process. Because data to inform judgements are often lacking, unmeasured factors should also be considered--explicitly and transparently. The process should include consultation with potential end users and other stakeholders, including the public, using well-constructed questions, and possibly using Delphi-like procedures. Groups that include stakeholders and people with relevant types of expertise should make decisions. Group processes should ensure full participation by all members of the group. The process used to select topics should be documented and open to inspection. SHOULD WHO HAVE A CENTRALISED OR DECENTRALISED PROCESS?: Both centralised and decentralised processes should be used. Decentralised processes can be considered as separate "tracks". Separate tracks should be used for considering issues for specific areas, populations, conditions or concerns. The rationales for designating special tracks should be defined clearly; i.e. why they warrant special consideration. Updating of guidelines could also be considered as a separate "track", taking account of issues such as the need for corrections and the availability of new evidence.

Journal Article↗
PubMed1989

Group well-child care offers unique opportunities for patient education.

By using a group process, health educators can greatly increase the cost effectiveness of well-child care. Benefits of group care, compared with traditional well-child care, include increased time for patient education, prolonged observation of parent-child interactions, the ability to observe children with their peers, and the opportunity to employ a broad variety of teaching techniques, such as role-modeling. This paper describes the author's 15 years of experience using this model, illustrating with examples the advantages of group well-child care.

Child Behavior↗
PubMedDate not supplied

Group therapy for partners of combat veterans with post-traumatic stress disorder.

TOPIC: An 18-month group-therapy experience with women partners of combat veterans with post-traumatic stress disorder (PTSD). PURPOSE: To describe the application of group process and feminist theory to the planning and development of a group of women partners of veterans with PTSD. SOURCE: The authors' clinical work. CONCLUSIONS: Using group psychotherapy theory and feminist theory, the group content and process involved the themes of rescuing, dissociation, and individuation. The exploration of transference and countertransference were useful in facilitating individual as well as process.

Adult↗
PubMed1979

Use of videotape feedback with severely disturbed adolescents.

A year of group therapy using videotape feedback with seriously disturbed adolescents offers evidence that such feedback facilitates the correction of these youngsters' distorted body images, low self-esteem, lack of capacity for self-observation, and poor peer relationships. The conscious use of videotape also played an integral part in the group process. It seemed to serve as a third therapist, with considerable amounts of resistance and transference focused on the equipment as it went through the process of being monster, toy and useful tool. An additional benefit was provided to the cotherapists in terms of supervision, and in teaching other staff the techniques of group therapy.

Adolescent↗
PubMed2005

Who helps the leaders? Difficulties experienced by cancer support group leaders.

GOALS OF WORK: Cancer support groups are an important source of support for cancer patients, yet little is known about the challenges and training needs of both professionally trained and untrained leaders. The aim of this study was to discover the difficulties experienced and training desired by cancer support group leaders. PATIENTS AND METHODS: Twenty-seven leaders of 34 cancer support groups participated in focus groups or individual interviews. Groups were purposively selected as representative of 173 support groups identified in New South Wales which were for adults with cancer and/or their adult carers and were not therapeutic or education-only groups. MAIN RESULTS: Difficulties identified included dealing with people's different communication styles and needs; dealing with recurrence, metastases and death; practical issues, including resources, setting the programme and funding security; maintaining personal balance and preventing burn out; establishing group credibility; dealing with group cycles; and leading groups in rural areas. Leaders also identified benefits and rewards from group leadership such as contributing to others' well-being, self-development and insight into others' lives. Non-professionally trained leaders experienced more difficulties, particularly in dealing with group process and practical issues. CONCLUSIONS: Difficulties identified were related both to working with a cancer population specifically and to working with groups in general. While some issues were common to both health professionals and non-health professionals, non-health professionals reported greater supportive needs. Clear guidelines, targeted training and development of better methods of support to reduce the stress and burn out experienced by group leaders are needed.

Adult↗
PubMed1999

Self-help groups for families of persons with mental illness: perceived benefits of helpfulness.

Self-help groups have become important resources for families of persons with mental illness. The present study was an attempt to understand the factors perceived by group members as helpful using Yalom's factors in clarifying the dynamics of groups. Members (N = 202) of the Alliance for the Mentally Ill of Pennsylvania (AMI of PA), an association of self-help groups for families of the mentally ill, were recruited and responded to a self-administered questionnaire. Hierarchical block multiple regression indicated that those AMI members who felt information provision and gaining support and self-understanding from the group process was helpful and were longer term participants in their group were more likely to perceive benefit from belonging to the group. The findings may provide the basis for evaluating and improving self-help group effectiveness and contribute to understanding process factors within a self-help group which members find beneficial. Implications for how these groups can attract and maintain members are discussed.

Adult↗
PubMed1995

Parenting groups for recovering addicts in a day treatment center.

This article describes parenting groups that were conducted at a day treatment center in New York City from 1989 to 1992. The population consisted of parents who were recovering from substance and alcohol addiction with backgrounds of poverty, educational deficits, and intergenerational addiction. The approach combined brief dynamic group therapy with the learning of child development, communication skills, and family management concepts in a psychoeducational model. Empathy and respect for the struggle of the recovering addict characterized the group culture and the stance of the group leader. The methodology included creative writing through group process, role playing, and values clarification activities. The high number of parenting group graduates who also completed the day treatment program suggests that parenting groups were a significant component in the recovery process. Clients in the groups reported feeling better about themselves as parents and were able to express more positive feelings toward their children.

Adolescent↗
PubMedDate not supplied

Using small-group instructional diagnosis and collaborative conflict resolution to facilitate course changes.

Small-group instructional diagnosis and collaborative conflict resolution are techniques that were successfully employed when course changes aimed at enhancing an undergraduate nursing leadership and management course with cultural diversity perspectives caused conflict among students and faculty. In this article these skills are described in relation to a specific situation; however, they both can have wide application. The small-group process can be conducted at midterm in any course, and conflict resolution techniques are applicable to most conflict situations, whether they occur in classrooms, with colleagues, or out of the workplace. Therefore, this article is intended for all faculty members who seek knowledge of formative classroom assessment techniques or help in managing conflict.

Adult↗
PubMed1986

Group therapy with sexually abused adolescent girls.

Clinical guidelines are presented for conducting group therapy with sexually abused adolescent girls, based on a literature review and the authors' clinical experience. Common treatment themes, pragmatic issues related to setting up a group treatment program, and group process issues are discussed.

Adolescent↗
PubMed1986

Work and defensive processes in small groups: effects of leader gender and authority position.

The effects of leader gender and degree of authority on work activity and group-as-a-whole defensive processes were examined in two Tavistock-model group relations conferences. The small groups in each conference had two leaders with different degrees of explicit authority, a consultant and associate consultant. In one conference, males were designated as consultants and females as associate consultants. In the second conference these role assignments were reversed. Segments of group interaction following leaders' interventions were scored for primary group activity (dependency, fight/flight, pairing or work) and individual member work. High authority leaders elicited more fight/flight than leaders with secondary authority, who in turn evoked more pairing. High authority female leaders tended to evoke more fight/flight activity than the males paired with them. Groups periodically responded with dependency regardless of leader gender or authority position. Group-as-a-whole work occurred infrequently. Individual work occurred, with no significant difference in frequency, in response to all leaders and in the midst of each group-as-a-whole defensive process.

Authoritarianism↗
PubMed1998

Shift report: a time for learning.

Shift report provides an opportunity for professional communication that supports role socialization and development of a cohesive group process in the health care system. In this learning project, nursing students were able to practice professional behaviors, prioritize information, and reduce material to the boundaries of a work setting without relinquishing the holistic approach to the client. Critical thinking, direct application, self-analysis, peer critiques, and problem-solving processes were used by the student groups which will assist in their role transition to professional nursing practice.

Communication↗