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PubMed1993

Somatization and the recognition of depression and anxiety in primary care.

OBJECTIVE: The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety. METHOD: The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. RESULTS: The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. CONCLUSIONS: While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.

Adolescent↗
PubMed1980

Contribution of an educational phase to stress inoculation of speech anxiety.

A study is described in which students anxious about speeches were treated by variations of stress inoculation training. The purpose of the experiemnt was to evaluate the contribution of an educational phase to the training. Three treatment groups received either the educational phase only, the skills phase only, or both. These were compared with a no-treatment control group. The education-only group was the only group to improve significantly on self-reported anxiety measured before giving a public speech. The education-only and combination group imporved on self-reported self-efficacy as a speaker. All groups improved on behavioral rating of anxiety. Discussion focuses on the apparent potency of using an educational model in the treatment of anxiety. Future research is suggested for delineating the conditions under which education is a powerful ingredient.

Anxiety↗
PubMed2006

Health education for youth.

Recent surveys monitoring health behavior in children and adolescents in Europe, Canada and the USA are reporting worrisome data in terms of health-risk behavior. Childhood and adolescence are critical periods in life for taking preventive measures, since this is the time when health-related behavior and lifestyles have their beginnings. The present paper attempts to introduce the art and science of health education with the ultimate goal of stressing the fact that health and education are strongly associated. Approaches to health education, models of intervention and recommendations by leading authors in the field are presented. Suggestions for sex education in children and adolescents are provided.

Adolescent↗
PubMed1991

Nurses as role models and health educators.

This paper focuses on the role of the nurse as both a role model and as a health educator and examines some key areas where tension between these two appear to exist. The context is the changing British National Health Service and the expectations of both the providers of the care and the consumers. The concept of the nurse as a role model for health is explored: the use of the term 'role' and its implications for nurses; what being a role model might mean for nurses and some of the stresses which living up to these role models might impose; the extra burden of an implied healthy role model and the expectations which are placed on nurses from both within and outwith the profession. Communication theory and the view of the nurse as a 'credible source' may add to these pressures and this paper tries to offer to nurses an alternative standpoint from which they may begin to tackle their health promotion/education activities. The traditional role of the nurse as a health educator is examined and a variety of options are offered to encourage nurses to consider their approach to dealing with clients within the context of health education. Some different models of education which are more suitable for the flexible approach which is required for health education are outlined. The paper closes with some discussion points which suggest that self-awareness and personal developments may be among the most important qualities which nurses need to be effective health educators.

Choice Behavior↗
PubMed2004

Historical interpretations of alcohol use and misuse. implications for nursing curricula.

Since the 1950's, nursing schools have been encouraged to include some formal content on alcoholism in their curricula. Yet there remains on immerse disparity between the prevalence of drug and alcohol problems in our society and the required number of hour on these topics in our nursing curricula. The International Nurses Society on Addictions calls on the nursing profession to promote healthy lifestyles for "at-risk" individuals. In a historical context, this article critiques the ambivalence related to alcohol use and misuse in the United States. Within that background, pedagogy to help nursing faculty and students meet current societal and professional demands and standards regarding intervention for alcohol-related problems will be explored. The constructivist educational and caring-educative models are highlighted.

Alcohol Drinking↗
PubMed2006

Lessons from the surgical experience with simulators: incorporation into training and utilization in determining competency.

Simulation technology in laparoscopic surgery has developed in response to a need to teach fundamental surgical skills in a safe environment. The skill set needed was defined carefully according to the classic educational model of needs assessment. Once defined, the skills were modeled in a simulator. The recognition that a simulator need not have high fidelity to achieve significant educational value was important in keeping costs reasonably low. Intrinsic to an effective simulation program is a set of metrics or measurements of performance. These metrics provide motivation for the student and allow comparison among students. Once shown to be reliable and valid, the simulator metrics can be used to set reasonable goals and standards for certification. Although simulators permit verification of learning, point simulation testing cannot by itself be used at present to ensure competence. Until the predictive value of these tests has been validated further, competence still needs to be determined by expert assessment of observed performance in real cases and by measurable outcome variables from real procedures. Simulation training is most beneficial when incorporated into a curriculum that teaches the accompanying knowledge and judgment essential for safe practice of the skills taught in the simulator. The FLS program distributed by the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons is an example of a carefully planned and validated program that incorporates these principles in laparoscopic surgery education. The lessons learned from development of the FLS program can be useful in designing a similar program for flexible gastrointestinal endoscopy.

Clinical Competence↗
PubMedDate not supplied

The essential forces of labor revisited: 13 Ps reported in womens' stories.

PURPOSE: The purpose of this study was to analyze women's birth stories. Women's perspectives were used to expand the current model of the essential forces of labor (the three Ps: powers, passenger, and passageway). DESIGN: This was a qualitative descriptive study analyzing women's birth narratives. METHODS: Narratives consisted of women's spontaneous responses to the request to tell their birth stories in any way they wished. Fifteen Midwestern women (eight primiparas and seven multiparas) were interviewed, resulting in a total of 33 birth stories. Content and thematic analyses of verbatim transcripts of the birth narratives were done to elicit women's personal meanings of control during labor. RESULTS: Women identified many essential forces of labor that exerted control or direction over their labors. Some of the forces were internal to the women, such as maternal psyche and position, as well as the classic three Ps (powers, passenger, and passageway). Others were external forces such as professional providers and procedures. An expanded model is proposed to demonstrate the complexity of labor and the multiple interacting forces. CLINICAL IMPLICATIONS: The educational model, consisting of three essential forces that currently appears in textbooks, is inadequate. Maternity nursing practice can be improved by including a broader array of the essential forces of labor, thus attending more adequately to the complexity of caring holistically and contextually for laboring women. Women indicated that nurses have a profound impact during labor. Nurses are in a position to make positive change by working with women to share control.

Female↗
PubMed1995

Use of integrated, general education, and community settings as primary contexts for skill instruction for students with severe, multiple disabilities.

Four students with severe, multiple disabilities learned to use four to five new skills at critical moments within age-appropriate activities. Instruction was provided only at moments critical to the continuation of the activities when natural cues and consequences delineated the need for the target behaviors. This method of intervention was combined with a more traditional package of antecedent prompt-fade procedures and, in a few instances, time delay. The purpose of the study was to analyze the effects of instruction given only at natural critical moments on the acquisition of basic sensory, motor, social, and communication behaviors. A multiple baseline design across skills within separate activities for four participants was employed. Fifteen of 17 skills were acquired to criterion. In addition, "learning to learn" effects occurred within each activity as instruction of new target behaviors was introduced. The outcomes are important for the participant population because they document the effect of integrated educational models for teaching the most basic skills. Discussion of the motivation provided by activity routines in general education and community settings, as well as interpretation of data when participants have the most severe disabilities, is presented.

Behavior Therapy↗
PubMed2004

Health promotion and disease prevention through sanitation education in South African Zulu and Xhosa women.

Poor sanitation and hygiene facilitate transmission of environmental diseases and pose a threat to the health of South African residents. This study focused on identifying sanitation needs from the perspective of informal community residents, addressing need related issues, and empowering Zulu and Xhosa women. The study used a multistep approach to identify and access communities of interest, reflexive critique during data collection from 300 heads of households, and a reiterative process to identify major themes. A process, which impacted 1,467 residents, was developed; it included culturally sensitive presentation styles and educational materials that facilitated understanding of sanitation concepts. Main sanitation themes were health knowledge and community role models. Educational sessions incorporated women. Using women as educators elevated their status and validated their community importance. Project participation added to the educational background of the Zulu and Xhosa women. It empowered them and provided an opportunity for them to articulate community needs.

Adult↗
PubMedDate not supplied

Models for evaluating nursing education programs.

Systematic evaluations of nursing educational programs can be difficult, time-consuming, contentious, and unrewarding processes. Yet there is little doubt of the value of a well-designed, systematic evaluation. Nurse educators and administrators currently face challenges to maximize the value of educational resources by increasing productivity, allocating resources appropriately, and accounting for their use. Credible, ongoing evaluations are necessary for meeting these challenges and maintaining high standards in nursing education. Several heuristic models are available to assist nurse educators and administrators in establishing systematic, ongoing processes of program evaluation. Each of the models described offers a slightly different perspective and organizing framework. Each also has various advantages and disadvantages, depending on individual program needs.

Education, Nursing↗
PubMed2002

The determinants of attitudinal change among medical students participating in home care training: a multi-center study.

PURPOSE: To report attitudinal changes of medical students from five medical schools rotating through a home care program, and to determine which of the program characteristics influenced attitudes the most. METHOD: A survey instrument covering four home care domains (general attitudes, home-based therapies, home care training, and time and reimbursement) was designed and validated by the five schools involved. Using pre- and post-rotation scores, analyses were done to evaluate for attitudinal changes within and among schools. The programs had similar basic characteristics (home visits, attending physicians' involvement, didactics), but had differing degrees of these components. RESULTS: Significant improvements in attitude scores were found in three domains: general attitudes, homebased therapies, and home care training. For time and reimbursement, only three schools improved significantly between pre- and post-rotation scores. Among the five schools, there were significant differences in the homebased therapies and home care training domains (p <.05), and in the time and reimbursement domain the difference approached significance (p =.06). None of the students' characteristics but all of the programs' characteristics significantly correlated with changes in total scores. In the first multiple regression model, educational level (third year instead of fourth) was the only independent predictor of change in score, (adjusted r(2) =.14). In Model 2, the strongest predictor was "contact with physician-program director," followed by "number of visits" and "physician-precepted visits" (r(2) =.23). CONCLUSION: Educational home care programs of varying intensities can positively affect medical students' attitudes towards home care. At least three program characteristics, (the physician-program director, number of visits, and physician-precepted home visits), are important parts of a successful program.

Adult↗
PubMedDate not supplied

[Indicators of educational assessment and prospects of improving university life].

INTRODUCTION: Five years after the establishment of the National Observatory for Assessment--now called National Committee for the Assessment of the University System--(L. 509/99), a critical analysis of the indicators chosen in relation to the aim suggested by the law itself becomes necessary. OBJECTIVE: To analyse the assessment system of the University Campus Bio-Medico as it has changed through time, in order to highlighten possible trends which have allowed a real improvement of the entire educational system. In these years our University has endeavoured to answer appropriately to the National Committee exhortations by creating its own system of self-assessment. This has strengthened the inner motivation to improve of all stakeholders of the educational process (students, teachers, tutors). The predominance of inner motivations on external ones is the essential feature in an university system which grants an educational model based on personal freedom and its related responsibility. This system, created and managed by the Department for Educational Research (DIE) of the University Campus Bio-Medico, is organized in three wider phases: planning of assessment tools and their administration; preparing the focus groups which address targeted groups of people so to evaluate the results and prepare new tools. RESULTS AND CONCLUSIONS: In our University assessment process certain values have acquired the structure of tracks along which it is possible to find concrete features: educational independence and planning governance as well as joint responsibility and cooperation. These are the key concepts which show the uniqueness and foundation of the entire educational system.

Educational Measurement↗
PubMed1989

Health information science at UVic: the student perspective.

The graduates and students of the School of Health Information Science (HIS) at the University of Victoria (UVic) have pioneered the Canadian sphere in health informatics since 1982. After six years of growth this co-operative education program has matured and establishment of a research base and graduate school has become a recent focus. In this context an evaluation of the HIS curriculum and co-op work experience from the student perspective was undertaken. Eighty-five persons, including 50 upper level students were surveyed. Thirty-five graduates were tracked and queried regarding their present employment, job satisfaction, future goals and perception of their professional status. In particular, students were queried on the retrospective value and/or shortcomings of the HIS co-op program. Their perceptions on the training that they have had or that they observe as leading to successful careers is documented. The student view on the ascribed role of 'change agent' and concerns regarding the lack of professional identity are noted. The implications of these findings on the future form of the Health Information Science curriculum and the direction of its educational model are subsequently discussed.

British Columbia↗
PubMedDate not supplied

Children's health promotion through caregiver preparation in pediatric brain injury settings: compensating for shortened hospital stays with a three-phase model of health education and annotated bibliography.

Shorter hospital and rehabilitation stays in cases of pediatric brain injury necessitate greater preparation and training of family caregivers, who often will be responsible for complex and continued care at home. At the same time, a growing nursing shortage results in less available time for individualized, one-on-one caregiver education in medical settings prior to discharge. What is needed are innovative models of caregiver preparation and education that are comprehensive, systematic, and maximize the use of health professionals' limited time. The model presented here aims to provide a progressive three-phase model of caregiver education that makes efficient use of health professionals' time and delivers crucial information in a time-released manner throughout the entire continuum of care under the guidance of health professionals. An annotated bibliography of published caregiver education resources and the appropriate time for their delivery to family members is provided in the Appendix.

Bibliographies as Topic↗
PubMedDate not supplied

Creating off-campus/distance learning courses for midwifery education. A brief introduction.

Midwifery education is undergoing a curriculum revolution that is reflective of current trends in other fields. Distance learning programs have developed in response to these changes. This article provides an overview of a student-centered transactional educational model, discusses the role of faculty as midwife-teachers, and reviews the factors influencing technology decisions for distance education. Curricular structure is discussed and ideas for learning activities are presented to assist faculty considering the development of off-campus, distance learning courses.

Curriculum↗