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That was a good meeting!

Good meetings are rare in many organizations. The purposes of meetings include sharing information, decision making, problem solving, education, planning, evaluation, and peer support. The structure of meetings flows from the basic function(s) of the group. Consideration is given to membership, degree of formality, limits of authority, and responsibility. Suggestions for successful meetings focus on establishing an agenda, sticking to the time schedule, appropriately using visual aids, and doing necessary post-meeting follow-up. Responsible and meaningful participation in the group process is an essential aspect of meeting effectiveness and efficiency. When all the elements are managed skillfully, the meeting can be GREAT.

Audiovisual Aids↗

Major factors influencing HIV/AIDS project evaluation.

This article aimed at finding out if participatory processes (group discussions, enactments, and others) do make a valuable contribution in communication-based project implementation/evaluation and the fight against HIV/AIDS. A case study backed by documentary analysis of evaluation reports and occasional insights from interviews stood as the main methods. To identify values, the state of beneficiaries prior to and after project implementation/evaluation was compared. Participatory processes were noted to have created an enabling environment for project beneficiaries to become activists for social change, leading to the limiting of the spread of HIV/AIDS through sexual behavior and a change of attitude--the essence required for successful intervention. Group participatory processes were also noted to have contributed in overriding, to a great extent, limitations arising from sociodemographic differences in the attainment of project objectives and limitations arising from differences in forms of evaluation (internal versus external evaluators).

Female↗

Cross-cultural differences in relationship- and group-based trust.

Two experiments explored differences in depersonalized trust (trust toward a relatively unknown target person) across cultures. Based on a recent theoretical framework that postulates predominantly different bases for group behaviors in Western cultures versus Eastern cultures, it was predicted that Americans would tend to trust people primarily based on whether they shared category memberships; however, trust for Japanese was expected to be based on the likelihood of sharing direct or indirect interpersonal links. Results supported these predictions. In both Study 1 (questionnaire study) and Study 2 (online money allocation game), Americans trusted ingroup members more than outgroup members; however, the existence of a potential indirect relationship link increased trust for outgroup members more for Japanese than for Americans. Implications for understanding group processes across cultures are discussed.

Analysis of Variance↗

Quality circles: one organization's experience.

Decentralization of quality assurance activity or total quality management (TQM) is a goal set by many health services. Effective and efficient use of available resources is usually the goal. This article describes the efforts of one organization to decentralize its nursing quality assurance program. Quality circles provided forums for an increasing acceptance by ward-based nurses of their role in establishing quality as central to nursing practice. This emphasis on local group processes has helped staff to work with each other to solve problems related to the work of nursing.

Attitude of Health Personnel↗

Primary nursing and quality of care: a Dutch study.

In an 850-bed Dutch hospital a study was carried out to compare the quality-of-care scores of a Primary Nursing group and a lagged experimental group. Process as well as outcome aspects of quality of care were investigated. The study consisted of three measuring moments: one pre-intervention at t1, March 1992, and two post-intervention moments at t2, November 1992 and t3, May 1993. The intervention was formed by the implementation of Primary Nursing in two experimental units after t1; this is the experimental group. After t2, Primary Nursing was also implemented in the three control units; this is the lagged experimental group. The process aspects of quality of care were covered by three dimensions: coordination of care, instrumental aspects of care and expressive aspects of care. The outcome aspects of quality of care were measured by evaluating four patient variables: self-care, initiative, patient stress and patient satisfaction. ANOVAs were used to test for significant differences between the experimental and lagged experimental group. The only significant difference in favour of the Primary Nursing group was found on the variable instrumental aspects of care. On the other variables no expected changes were observed. Finally, the implications of the findings are discussed.

Analysis of Variance↗

Time-limited, group psychotherapy for borderline patients.

Preparation for treatment, group process and time boundaries are presented as components of a treatment model designed to respond to specific problems inherent in the nature of borderline personality disorder. A pilot study of the proposed treatment model is underway and one case illustration from this study is described to illustrate the adaptation to this treatment of a borderline patient with an extensive prior history of individual treatment.

Adaptation, Psychological↗

Validation of an inclusive model of sexual minority identity formation on a sample of gay men.

This article outlines the preliminary validation of a new, inclusive model of sexual minority identity formation (McCarn & Fassinger, 1996) on a sample of gay men. The model hypothesizes two separate but reciprocal processes of individual sexual identity development and group membership identity development in a four-phase developmental sequence. The model was developed and successfully validated on a sample of lesbians (briefly described here), and the present study replicates and extends this work, using a modified Q-sort methodology, on a sample of 34 diverse gay men. Results indicated support for the model, in terms of both individual and group processes as well as phases, and suggested that the model is applicable to gay men. Implications of the study for theory, research, and practice are discussed.

Adult↗

The care and feeding of small-group leaders of sex discussion groups.

This paper will focus on the selection, training, and monitoring of the small-group leaders in an extensive program of sex education. While not explicitly therapeutic, the leadership role in the six small-group sessions held during a 2-day period, covering highly emotional material, demands the skills and sensitivities of the traditional group therapist. In addition, group leaders must be aware of the limits of this experience and the subtle effect of a leader's role modeling during group discussion. The paper will discuss the SAR model, its academic history, and our experience with over 200 leaders drawn from both professional and paraprofessional ranks. We have data on participant evaluation of leaders and have developed a series of concepts regarding group process which is fed into our training program. Qualitative assessment of characteristics of the effective sex group leader is now possible as are basic group and member issues that most leaders must handle. The paper will discuss leadership screening, early orientation, small-group training sessions, practice leadership, supervision, evaluation, and problem solution in this highly sensitive area of sexuality, which while educational in purpose, is therapeutic in process.

Education, Medical↗

[Substantiation and varieties of complex surgical treatment tactics for pyo-necrotic forms of diabetic foot].

For the period from 1996 to 1998 in the Division of wounds and wound infection of A.V. Vishnevsky Institute of Surgery 92 patients with pyonecrotic forms of "diabetic foot" underwent thorough examination and treatment. The patients were divided into groups by the form of "diabetic foot": with pyonecrotic forms of "diabetic foot" without critical ischemia (group 1) and with it (group 2). In 18 patients of both groups the data of electron autoradiography were used to reveal peculiarities of the wound process. Group 1 patients had at admittance a large number of neutrophiles in various stages of destruction in biopsies of the wound. In patients of group 2 a great majority of the vessels in biopsies of the wound were in different stages of destruction with lost connections between their separate cells or some of their part absent. Separate cells (endotheliocytes and pericytes) which make up the walls of destroying vessels, were synthesizing RNA and were functionally active. In both groups, the studied parts of the wound before plastic repair of its defect usually represented as well developed granulation tissues with a number of microvessels and cells. Intensive synthesis of PNA in the cells of microvascular wall evidenced of their high functional activity, and the synthesis of DNA in them showed their ability for proliferation, i.g.--for growth. Thus, microangiopathy was reversible, and the solution of the problem of critical ischemia should be considered in the light of macroangiopathy. Thus, in patients of group 1 the cause of pyonecrotic damage consists in infection process, while in patients of group 2--in combination of infection with ischemia of the extremity. In both groups pyonecrotic disease of the extremity ruses at the background of severe disturbances of cellular immunity.

Diabetic Foot↗

Interprofessional education for undergraduate students.

Collaborative practice is an essential component of public health nursing. Using an interprofessional collaboration process, community health nursing and social work faculty developed joint classroom instruction and clinical experiences for their students. In partnership with a neighborhood organization, the undergraduate nursing and social work students conducted a community assessment and recommended a plan of action. Analysis of the student collaborative practice revealed both similarities and differences in role perceptions, group process, problem solving, and discipline-specific values and attitudes. Logistical concerns revolved around student scheduling and communications. Based on the analysis, specific recommendations are provided for faculty in developing student collaborative experiences across disciplines.

Attitude of Health Personnel↗

The study of nursing documentation complexities.

This study aimed to explore complexities in nursing documentation and related factors. Nursing documentation has been one of the most important functions of nurses since the time of Florence Nightingale because it serves multiple and diverse purposes. Current health-care systems require that documentation ensures continuity of care, furnishes legal evidence of the process of care and supports evaluation of quality of patient care. However, nursing documentation has not served such objectives because of its complexities. This study explores nursing documentation complexities and related factors through both qualitative and quantitative methodologies. The study used multiple methods of inquiry: in-depth interviewing; participant observation; nominal group processing; focus group meetings; time and motion study of nursing activities; and auditing of completeness of nursing documentation. Complexities in nursing documentation include three aspects: disruption, incompleteness and inappropriate charting. Related factors that influenced documentation comprised: limited nurses' competence, motivation and confidence; ineffective nursing procedures; and inadequate nursing audit, supervision and staff development. These findings suggest that complexities in nursing documentation require extensive resolution and implicitly dictate strategies for nurse managers and nurses to take part in solving these complicated obstacles.

Documentation↗

Quality in the interorganizational setting.

For many patients, important health services are delivered by a process of care that spans several service organizations. Issues influencing the quality of care delivered across organizations are infrequently discussed in the health care quality literature. In this paper, interorganizational quality problems that detract from the care received by children with spina bifida, lead poisoning, and children who have been sexually abused are identified. Using concepts from the organizational behavior literature, both structural and group process approaches to addressing these problems are discussed to enhance the care received by children. A broader conceptualization of care delivery is required if patients whose care spans institutions are to benefit from quality improvement efforts.

Child↗

Teaching EBM facilitation using small groups.

The problem-centered, learner-focused, small-group process (PLS) is used by faculty to train learners in evidence-based medicine (EBM). Few affordable and accessible courses exist to train faculty in the PLS process. The results of a novel course to train faculty in the PLS process are described. The course was a one-day workshop consisting of five small group sessions with two facilitators. The participants were seven clinicians and four medical librarians. The initial small-group session was a discussion of concepts and principles related to successful facilitation skills; the subsequent four small groups reinforced these concepts and principles with role-playing and case scenarios using different steps in the EBM process. The course, including the use of the PLS process, scored highly on participant evaluations. The authors conclude that the introductory course effectively taught the PLS process for use in EBM facilitation.

Education, Continuing↗

Molecular motions in chitosan studied by dielectric relaxation spectroscopy.

Neutralized and nonneutralized chitosan films subject to different thermal treatments were studied by dielectric relaxation spectroscopy from -130 to +150 degrees C in the frequency range between 20 Hz and 1 MHz. Two main relaxation processes, both arrhenian type, were detected: process I at temperatures below 0 degrees C with a mean activation energy of 49 +/- 1 kJ mol(-1), which has the characteristics of a secondary relaxation process related with local chain dynamics, and process II observable at higher temperatures with an activation energy of 94 +/- 2 kJ mol(-1), correlated with dc conductivity, which is found in dried polysaccharides systems. Process I is always observed in neutralized chitosan, but it is strongly depleted in the wet nonneutralized form. Although the location of process I is independent of NH2/NH3+ side group, process II deviates to higher temperatures with dryness in both chitosan forms, being located at lower temperatures in nonneutralized chitosan.

Chitosan↗

Factors affecting group therapy outcome for adult sexual abuse survivors.

Adult female sexual abuse survivors (N = 148) participated in year-long therapy groups. Demographic, abuse history, initial symptomatology, and group process variables were examined in relationship to group completion and improvement over time. Survivors who had previously been psychiatrically hospitalized were less likely to complete group treatment. Among group completers, significant pretreatment-posttreatment changes were found on measures of locus of control, sexual problems, self-esteem, trauma-related symptomatology (TSC-33), and general psychological distress (SCL-90-R). Greater changes on the SCL-90-R were found among Caucasian women, women with more initial trauma-related symptomatology, women whose abuse included intercourse, members of groups with similar abuse histories, and women with previous psychotherapy experience.

Adolescent↗

Reminiscing therapy: a CNS intervention.

The role of the clinical nurse specialist (CNS) has expanded over the years. The CNS is prepared through education and training with group process to initiate and implement a reminiscing group for the elderly. Life review and reminiscing are dynamic occurrences in which the individual is an active agent. The implementation of the program with documentation can be kept simple. A nondirective approach may be used to allow the participants to form the group in the manner that is most comfortable for them. By using reminiscing techniques, the CNS can enhance the quality of the elderly's later years, as well as facilitate their last developmental task.

Aged↗

Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: use of restraining therapies--American College of Critical Care Medicine Task Force 2001-2002.

OBJECTIVE: To develop clinical practice guidelines for the use of restraining therapies to maintain physical and psychological safety of adult and pediatric patients in the intensive care unit. PARTICIPANTS: A multidisciplinary, multispecialty task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM), the Society of Critical Care Medicine (SCCM), and the American Association of Critical Care Nurses (AACN). EVIDENCE: The task force members reviewed the published literature (MEDLINE articles, textbooks, etc.) and provided expert opinion from which consensus was derived. Relevant published articles were reviewed individually for validity using the Cochrane methodology (http://hiru.mcmaster.ca/cochrane/ or www.cochrane.org). CONSENSUS PROCESS: The task force met as a group and by teleconference to identify the pertinent literature and derive consensus recommendations. Consideration was given to both the weight of scientific information within the literature and expert opinion. Draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft then was reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. CONCLUSIONS: The task force developed nine recommendations with regard to the use of physical restraints and pharmacologic therapies to maintain patient safety in the intensive care unit.

Adult↗