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PubMed2002

[Surgical decision making and behavior. Social psychology explanations and research perspectives].

Social psychology is the discipline that investigates thought processes, emotions, and behaviors in the interpersonal context. There are three broad topic domains: understanding oneself and other persons, interpersonal relations, and group influence. The most important method is the experiment. The value of the social psychological perspective is illustrated with regard to the following surgical research questions: How do surgeons arrive at their decisions? How do surgeons confirm their decisions? Why do decision aids (computer support, guidelines) receive so little acceptance? How should patients be informed? Which group processes play a role in the operating theatre? What are the determinants of patient outcomes? Social psychology can extend surgical research in three respects: better understanding of everyday phenomena in the clinical and surgical arena, methodologically refined and stronger patient-oriented study designs, and new perspectives for improved patient outcomes.

Adult↗
PubMed1991

Group treatment of the hyperventilation syndrome.

Hyperventilation (hv) is increasingly recognized as being significant in a number of psychological and medical conditions. The core of treatment for hv is breathing retraining, usually on an individual basis. This article describes a group therapy for breathing retraining for patients with hv-induced panic reactions. An analysis of group process suggests that such treatment is helpful in ways impossible for individual retraining and that further exploration of this modality is warranted.

Anxiety Disorders↗
PubMed2005

The focus group method: insights from focus group interviews on sexual health with adolescents.

This article concerns the manner in which group interaction during focus groups impacted upon the data generated in a study of adolescent sexual health. Twenty-nine group interviews were conducted with secondary school pupils in Ireland, and data were subjected to a qualitative analysis. In exploring the relationship between method and theory generation, we begin by focusing on the ethnographic potential within group interviews. We propose that at times during the interviews, episodes of acting-out, or presenting a particular image in the presence of others, can be highly revealing in attempting to understand the normative rules embedded in the culture from which participants are drawn. However, we highlight a specific problem with distinguishing which parts of the group interview are a valid representation of group processes and which parts accurately reflect individuals' retrospective experiences of reality. We also note that at various points in the interview, focus groups have the potential to reveal participants' vulnerabilities. In addition, group members themselves can challenge one another on how aspects of their sub-culture are represented within the focus group, in a way that is normally beyond reach within individual interviews. The formation and composition of focus groups, particularly through the clustering of like-minded individuals, can affect the dominant views being expressed within specific groups. While focus groups have been noted to have an educational and transformative potential, we caution that they may also be a source of inaccurate information, placing participants at risk. Finally, the opportunities that focus groups offer in enabling researchers to cross-check the trustworthiness of data using a post-interview questionnaire are considered. We conclude by arguing that although far from flawless, focus groups are a valuable method for gathering data about health issues.

Acting Out↗
PubMed1987

Clinical pastoral education: seasons of a group's life.

Proposes a model of small group processes which may be used as a guide by supervisors conducting programs in Clinical Pastoral Education. Outlines and discusses structures in a group's life--early life, mid-life, late life, and transitional phases--and notes the characteristic behavior of group members in each phase. Proposes ways of leadership functions throughout the life of the small group, illustrating with vignettes.

Australia↗
PubMed2006

[Health promotion groups for improving autonomy, living conditions and health].

This article presents the methodology of Health Promotion Groups, which were conceived as a means of contributing towards developing autonomy, improving living conditions and promoting health. The method is identified as a collective and interdisciplinary health intervention, consisting of a group process. It guides the development of attitudes and behavioral patterns towards continually transforming participants' health levels and living conditions. The Health Promotion Groups are identified within the context of the National Health System (Sistema Unico de Saúde) as a means of surpassing the biomedical model. It stimulates the development of actions in which the positive aspects of health are emphasized, while at the same time it can serve to more effectively meet the demands for care for the elderly in health systems.

Aged↗
PubMed2002

A systematic program to enhance clinician group skills in an inpatient psychiatric hospital.

This article describes the collaborative effort of a team of discipline directors, administrators, and academicians to create a systematic program to enhance the group competencies of a large clinical staff working at a state hospital. The effects of the program were tested by a quasi-experimental field study. Quantitative measures of group process provided limited support for program effectiveness. Stronger support came from qualitative inquiry. The development and effectiveness of the program is examined within a larger context of group programs housed in large health care organizations.

Adolescent↗
PubMed1992

The interpersonal approach to group psychotherapy.

The interpersonal model of group psychotherapy emphasizes the critical nature of peer interactions and consequent dynamic interpersonal learning. The author illustrates basic concepts of the model through a series of clinical vignettes. The central importance of the group as a social microcosm, cohesion and group process, here-and-now activation, and corrective emotional experience are documented, as is the role of the therapist in facilitating interpersonal feedback and effective therapeutic work.

Adult↗
PubMed2004

What works for survivors of childhood abuse: learning from participants in an inpatient treatment program.

Thirty adults were interviewed about their experiences in a 6-week program for recovery from posttraumatic stress. The most valued aspects were their relationships with staff and the staff's expertise in treating the long-term effects of abuse. They valued the structured group treatment that allowed them to process emotions with the goal of healing. A few were upset by process groups, whereas others had difficulty with the sudden loss of support at discharge from the program.

Adult↗
PubMed2005

Sessions, cyphers, and parties: settings for informal social controls of blunt smoking.

The importance of settings for marijuana use has been widely noted, but the way that informal social controls are organized to moderate the amounts consumed have not been well documented. A major ethnographic study of blunts/marijuana use in New York City observed several hundred marijuana users in group locations and conducted intensive interviews with 92 focal subjects. The vast majority of blunt smokers preferred to consume in a group setting. Participants identified three group settings in which blunt smoking often occurred-sessions, cyphers, and parties. The analysis identifies various conduct norms, rituals, and behavior patterns associated with each of these settings. Regardless of the setting, group processes encouraged equal sharing of blunts, moderation in consumption, intermission and breaks between smoking episodes, and involvement in non-smoking activities. Blunt smoking groups rarely encouraged high consumption and intoxication from marijuana.

Adolescent↗
PubMed1998

Using teams and committees effectively.

In a corporate setting, the term "team" usually refers to members of a group with different responsibilities and/or skills working together to achieve a common goal or objective. The major reason why a company desires group as opposed to individual involvement is to derive sounder decisions. Two essential issues to resolve in establishing teams or committees are 1) who should be a member or representative; and 2) what is the charter or mandate for the group. Representatives join a team or group in numerous ways; four common methods are 1) appointment by the group member's supervisor; 2) recruitment by the team leader; 3) appointment by a senior manager; and 4) volunteering. There are various profiles of how groups can approach a decision, including "groupthink," the "ideal group process" and the "debating society" approach. Group meetings must be structured to ensure that decisions are reached and then implemented. Foresight and planning are essential prerequisites to have efficient teams and committees that work effectively and achieve their goals.

Journal Article↗
PubMed1989

Reminiscence--when the past eases the present.

1. Fostering reminiscence in a group is an appropriate nursing intervention for a variety of nursing diagnoses, or simply to enhance the general quality of life of elderly clients. Reminiscence groups have been used by nurses in a variety of settings with a variety of types of clients, and have been associated with psychological and social benefits. 2. If participation is voluntary and leadership style is nonjudgmental and supportive, a reminiscence group should have a positive impact on elderly participants. 3. Sharing memories in a group situation may not come naturally to elderly clients. By giving thought in advance to the group's purpose, structure and rules, leadership style, and group process, the leader can enhance the group experience for both herself and the elderly participants.

Aged↗
PubMed2003

Creative learning: the mandala as teaching exercise.

Faculty committed to undergraduate education have discovered the need to address teaching strategies that focus on the new generation of students. In teaching an undergraduate course on Nursing the Client with a Mental Illness, the affective domain of learning is used to develop interpersonal competence, self-awareness, and self-reflection. The teaching technique used is an experiential exercise that asks students to create group mandalas using art materials on circular pieces of butcher-block paper. The mandala concept is derived from the Buddhist tradition and means "circle" or "center" in Sanskrit. Carl Jung introduced this technique to the United States and incorporated it into his therapy. As a creative, active learning strategy, the mandalas helped the faculty meet the clinical objectives for the course and the learning needs of a new generation of students. They also helped students learn about Eastern philosophy, group process, self-awareness, and Jungian therapy.

Art↗
PubMedDate not supplied

[Clinical usefulness of oligoclonal bands].

The presence of oligoclonal bands (OCB) of immunoglobulin G (IgG) is in our days the most useful finding in the study of the CSF for the diagnosis of multiple sclerosis (MS). The most sensitive method for the detection of OCB is the isoelectric focusing followed by immunoblotting. The prevalence of OCB changes in different populations with a rank of results from 60 to 95 97%. We have determined the prevalence of OCB in our population and the sensitivity and the specificity of the technique used in our laboratory. We have included 391 patients in whom we analysed the presence of OCB, subdivided in; Group 0: Diagnosed of MS, group 1: First episode of demyelinating process, group 2: Neurological disorders considered noninflammatory or nonautoimmune (NINA),group 3: Neurological disorders considered inflammatory, infectious or autoimmune (IIA). The presence of OCB was searched in CSF and serum simultaneously using isoelectric focusing and immunoblotting. In order to standardize the technique we achieved and internal and external validation. Internal validation: sensitivity and specificity (using as a control group first the group NINA and after the group IA). External validation: we choose 10 pairs of CSF/serum from patients with different diagnostics and sent to a reference laboratory ( Karolinska Institute Medical School) that was blind of our results and of the diagnostics. The prevalence of OCB in each group has been: group 0 (MS): 87.7%, group 1: 54.8%, group 2 (NINA): 17.5%, group 3(IIA): 52.7%. Sensitivity: 97.7%, specificity using group NINA as control 82.5% and using group IIA 45.7%. Concordance with the reference laboratory in 9/10 determinations. We conclude that in our population the prevalence of OCB, in patients with MS, is lower than in Northern Europe. The OCB appear in may inflammatory, autoimmune diseases, their specificity for the diagnostic of MS is low.

Autoimmune Diseases↗
PubMed1997

Self-scheduling can work.

After forming a unit-based scheduling committee, a flexible scheduling option was designed: a 10-hour evening shift. The group process--planning, implementing and evaluating flexible schedule options--is given.

Group Processes↗
PubMed1998

A report from the Second International Forum for Primary Care Research on Low Back Pain. Reexamining priorities.

STUDY DESIGN: Consensus process. OBJECTIVES: Reexamining and redirecting the research agenda for low back pain in primary care. SUMMARY OF BACKGROUND DATA: Most research, publications, and funding have traditionally been directed toward specialty and biologically oriented investigations of "spinal disorders" from biomedical and biomechanical perspectives. Beginning in the mid-1980s, primary care researchers began to investigate this field in earnest, focusing on lower back pain as a pain syndrome within an individual, family, and community context. Unfortunately, more progress has been made on what should not be done in diagnosing and treating lower back pain than on what should be done. METHODS: This was a modified group process designed to reach consensus among an international group of primary care lower back pain researchers. RESULTS: Nearly all of the research priorities from the initial 1995 forum are still thought to be important, although only modest progress has been made on most of them. The priorities perceived to be the most feasible to investigate and the ones in which the greatest strides have been achieved are in methodologic rather than substantive areas. Identifying subgroups of people with lower back pain is still given top ranking in 1997, but the priorities have changed dramatically. Greater emphasis is given to finding predictors and risk factors for lower back pain chronicity, improving self-care strategies, and stimulating self-reliance. New items now make up 50% of the top 10 priorities. In general, the additions reflect a greater emphasis on expanding methodologic avenues of inquiry. CONCLUSIONS: Methodologic advances, the enlistment of new techniques and disciplines, and redirected research efforts may facilitate progress in the diagnosis and treatment of lower back pain.

Group Processes↗
PubMed1996

Evaluating the use of the appropriateness method in the Agency for Health Care Policy and Research Clinical Practice Guideline Development process.

OBJECTIVE: To assess the feasibility of the appropriateness method in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline Development process, and to compare the results of the appropriateness method with those obtained using evidence tables and an informal consensus method. SETTING: AHCPR Low Back Problems Clinical Practice Guideline. DESIGN: Two different group process methods with the same panel of experts were used in observational comparison of results of and satisfaction with guideline development. DATA COLLECTION: Practice guideline statements were created for topics using the conventional AHCPR method; then six months later new guideline statements for four topics were created using the appropriateness method. Panelist satisfaction with each process and resulting set of guideline statements was assessed. PRINCIPAL FINDINGS: Results of the appropriateness method for TENS, discography, and traction showed no disagreement among panel members and no appropriate indications for their use in the patient scenarios considered. These results are qualitatively similar to the guideline statements produced using evidence tables and informal consensus. Clinical practice guideline statements about electro-diagnostics created from appropriateness ratings were much more clinically specific than those created using evidence tables and informal consensus. Neither informal consensus building nor the appropriateness method was clearly preferred by a majority of panelists. CONCLUSIONS: It is feasible to use the appropriateness method in the AHCPR Clinical Practice Guideline Development process, and in some instances it produces more clinically specific guideline statements than does informal consensus.

Acute Disease↗
PubMed1995

Is consensus reproducible? A study of an algorithmic guidelines development process.

The authors evaluated the reproducibility of a clinical algorithm consensus development process across three different physician panels at a health maintenance organization. Physician groups were composed of primary care internists, who were provided with identical selections from the medical literature and first-draft "seed" algorithms on the management of two common clinical problems: acute sinusitis and dyspepsia. Each panel used nominal group process and a modified Delphi method to create final algorithm drafts. To compare the clinical logic in the final algorithms, the authors applied a new qualitative and quantitative comparison method, the Clinical Algorithm Patient Abstraction (CAPA). Dyspepsia algorithms from all physician groups recommended empiric anti-acid therapy for most patients, favored endoscopy over barium swallow, and had very similar indications for endoscopy. The average CAPA comparison score among final physician algorithms was 6.1 on a scale of 0 (different) to 10 (identical). Sinusitis algorithms from all groups proposed empiric antibiotic therapy for most patients. Indications for sinus radiographs were similar between two algorithms (CAPA = 4.9), but differed significantly in the third, resulting in lower CAPA scores (average CAPA = 1.9, P < 0.03). The clinical similarity of the algorithms produced by these physician panels suggests a high level of reproducibility in this consensus-driven algorithm development process. However, the difference among the sinusitis algorithms suggests that physician consensus groups using a consensus process that a health maintenance organization can do with limited resources will produce some guidelines that vary due to differences in interpretation of evidence and physician experience.

Acute Disease↗
PubMedDate not supplied

Clinical placement: prebriefing and debriefing as teaching strategies.

This paper discusses use of debriefing processes as a teaching strategy. Such an everyday session in the clinical setting is distinguished from conventional debriefing in critical incident or post-trauma emergency situations. The group processes described can also be used to defuse fears before students experience clinical placement. Debriefing sessions are most valuable following the clinical placement day when students' heads may be whirling from over-stimulation of various kinds. The sessions facilitate use of therapeutic communication skills. They work with student emotions and affirm feelings as an integral aspect of teaching-learning. They also provide a forum in which students may practise assertive interventions in role play relevant to specific unsatisfactory interactions experienced on the ward. Positive feedback from the clinical teacher and peers helps build up student confidence.

Emotions↗