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The role of the advanced clinical nurse in a hypertension clinic.

The use of advanced clinical nurses (ACNs) has enabled expansion of the Hypertension Clinic at the Johannesburg Hospital. The ACNs care for elderly patients whose hypertension is stable and who require a minimum of drugs. Blood pressure control in this group of patients is satisfactory and the default rate is low. The ACN therefore appears acceptable, at least to the patient. However, problems of continuing education, evaluation and official recognition remain. The case for allowing the ACN to prescribe from a limited pharmacopoeia is presented.

Humans↗

[Problem-based medical teaching].

A possible method of improving teaching at faculties of Health Sciences is the so-called problem-based teaching method. A student is presented with a (clinical) medical case, which is to be investigated. By means of this method, the student himself will, under guidance, formulate his individual lack of knowledge, goals, priorities, methods, and evaluation. Educational observations show that the learning process is better when the problem-solving takes place among a group of students. A tutor acts as a catalyst for the process and gives feed-back through the problem-solving. He is therefore not an intermediary of knowledge to the group, but primarily refers the student to literature or knowledge experts at the faculty. International studies have not proven any unequivocal improvement in the students' ability to pass exams or to work as doctors, but both teachers and students seem to be more satisfied with the teaching method, which has stimulated the wish to study. The use at other faculties has not caused any large increase in expenditures. This should result in an increased use of problem-based teaching in medical education.

Denmark↗

Cognitive functioning and brain magnetic resonance imaging in children with sickle Cell disease. Neuropsychology Committee of the Cooperative Study of Sickle Cell Disease.

OBJECTIVE: Brain magnetic resonance imaging (MRI) and neuropsychological evaluations were conducted to determine whether neuroradiographic evidence of infarct in children with sickle cell disease between ages 6 and 12 years would result in impairment in cognitive and academic functioning. METHOD AND DESIGN: Children enrolled in the Cooperative Study of Sickle Cell Disease were evaluated with brain MRI and neuropsychological evaluation. Completed studies were obtained for 194 children, 135 with HbSS. MRIs were categorized according to the presence of T2-weighted, high-intensity images suggestive of infarct and were further categorized on the basis of a clinical history of cerebrovascular accident (CVA). An abnormal MRI but no clinical history of CVA was classified as a silent infarct. Neuropsychological evaluations included assessment of both global intellectual functioning and specific academic and neuropsychological functions. RESULTS: Central nervous system (CNS) abnormalities were identified on MRI in 17.9% of the children (22.2% of children homozygous for HbS), and a clinical history of CVA (N = 9, 4.6%) was identified in only children with HbSS disease. Subsequent analyses examined only children with HbSS. Children with a history of CVA performed significantly poorer than children with silent infarcts or no MRI abnormality on most neuropsychological evaluation measures. Children with silent infarcts on MRI performed significantly poorer than children with no MRI abnormality on tests of arithmetic, vocabulary, and visual motor speed and coordination. CONCLUSIONS: These results substantiate the importance of careful evaluation, educational planning, and medical intervention for CNS-related complications in children with sickle cell disease.

Anemia, Sickle Cell↗

Associations between measures of socioeconomic status and maternal health behavior.

Lower socioeconomic status (SES) is consistently associated with adverse pregnancy outcomes. One mechanism that may account for this association is that maternal health behaviors vary with SES. To examine this possibility, we addressed how women may be differently categorized by diverse measures of SES and the effect that choice of measure has on the relationship between SES and maternal health behaviors. We used population-based data for Caucasian women (n = 10,055) from Alaska, Maine, Oklahoma, and West Virginia who delivered a live infant in 1990-1991 and participated in the Pregnancy Risk Assessment Monitoring System. Five SES measures were evaluated: education; poverty status; Medicaid payment for delivery; Women, Infants, and Children (WIC) enrollment during pregnancy; and residential crowding. Three maternal health behaviors (smoking, delayed/no prenatal care, unintended pregnancy) were examined to assess the variation among the associations between SES measures and behaviors. Item response rates were high for all SES measures (range: 88.9%-100.0%), and there was low correlation between measures. Most of the SES measures were related to maternal health behaviors. However, the strength of association varied between each measure and behavior and was weaker for women who were younger than 20 years old or not married. In view of the multifaceted nature of SES, several measures may be needed to appropriately assess the relationship between SES and maternal health behaviors.

Female↗

Barriers to assertive skills in nurses.

The role of nursing involves interaction with clients, peers and other health professionals. This role is enhanced when nurses have a good command of communication skills. An essential component of effective communication is the ability to behave assertively. Several studies have indicated that nurses lack assertiveness skills. This lack of assertiveness results in diminished effectiveness of communication and compromised patient care. The purpose of this study was to examine the barriers, identified in the literature, that prevent nurses from being assertive and to determine nurses' perceptions of how these barriers prevent them behaving assertively. The design of the study was a cross-sectional, correlational survey whereby the relationships between identified variables could be systematically investigated. Assertiveness was assessed using the Assertiveness Behaviour Inventory Tool (ABIT), and the Barriers to Assertive Skills in Nurses (BASIN) were assessed using an instrument developed for the study by the investigators. The validity and reliability testing of the BASIN instrument is discussed. The results indicated that the 152 nurses sampled considered themselves to have moderate to low assertiveness skills, and a significant negative correlation was found between the level of assertiveness and the perception of barriers inhibiting assertive behaviour. The study concluded that assertiveness training is needed for qualified nurses and that further testing of the ABIT and BASIN instruments will result in reliable measures for research and educational evaluation of nurses following assertiveness training.

Adult↗

[Palliative medicine. A new research field with specific demands].

Palliative care is not merely a question of treating symptoms irrespective of cause, but is ideally based on proper analysis, treatment and evaluation. Education, quality assurance, clinical development and research are needed to improve palliative care. Education and research should be focussed on all four dimensions--the physical, the emotional, the social, and the existential. Research should be designed to address specific issues--for example, how anxiety and mood disturbances in (previously healthy) patients in palliative care differ from anxiety and depression in a psychiatric setting, in patients with a history of psychiatric problems. Efforts need to be made to link significant clinical problems and basic science. Not until we understand the underlying mechanisms (e.g., the involvement of cytokines in mediating cachexia), will it be possible to develop new treatment strategies for problematic symptoms.

Crisis Intervention↗

[Development and evaluation of an educational software for pediatric nursing education].

Computer Science is being introduced in education at an accelerated pace, thus forcing educators and students to become familiarized with such technology. This study aimed at the development and evaluation of the educational software "Children and medication". The program utilizes multimedia resources in four topics: the child, medication, the person who administers and administration of medication. The evaluation showed a large acceptance of the program, with most of the items being rated as excellent. We emphasize the importance of the development of teaching strategies utilizing computer resources in nursing education and in the development of nurses for the new millenium.

Evaluation Studies as Topic↗

A framework for the evaluation of continuing education short courses in dentistry.

The objective of this paper is to propose an evaluation framework for short courses in continuing education for general dental practitioners (GDPs) (so called, Section 63 courses). Existing monitoring and evaluation procedures in the West Midlands deanery were examined and an improved evaluation framework was then devised, piloted and revised. A 5 phase method was used incorporating the examination of existing practice (Phases 1 and 2), development of a new framework (Phase 3), piloting (Phase 4) and revision of the evaluation framework in the light of the pilot. This approach will be implemented in the West Midlands and may be adapted for national use (Phase 5). It was found that existing monitoring and evaluation was inconsistent in prevalence and scope. Those involved in short courses were in favour of a more consistent and visible evaluation, including some assessment of impact-on-practice and cost-effectiveness. In conclusion, meaningful evaluation needs to include four key processes: data gathering; data analysis; dissemination and, action planning (reviewing provision in the light of the data analysis). Thus, this evaluation framework feeds into a quality development cycle designed to ensure high quality and relevant short course provision for general dental practitioners.

Cost-Benefit Analysis↗

Prospective evaluation of an educational programme for physicians involved in the management of syncope.

AIM: Management of patients (pts) presenting syncope diverges markedly from the guidelines of the European Society of Cardiology (ESC). To improve this management, the easiest option seemed to be to educate physicians. The aim of the study was to evaluate the impact of an educational process on the use of unnecessary neurological investigations. METHODS AND RESULTS: Charts of pts presenting syncope during two 12-month periods (1999-2000 and 2002-2003) to the emergency department were systematically reviewed. Between the two periods, all physicians in charge of pts with syncope attended educational meetings. During these meetings recommendations of the ESC were presented with a special emphasis on the uselessness of neurological investigations. Four hundred and fifty-four pts (1.2%) presented to the emergency department for syncope during study period 1, and 524 (1.3%) during study period 2. Nineteen of the 169 pts (11%) directly discharged from the emergency department, had neurological investigations during study period 1 and 22 of the 279 (8%) during study period 2 (NS). In pts who were hospitalized, 48% had neurological investigations in groups 1 and 2. CONCLUSION: Education of physicians in charge of patients with syncope is inadequate to improve the cost effectiveness of the management of these patients.

Aged↗

[Modular training in practical medicine: electronic evaluation of student education in general practice].

Effective from spring 2004, new regulations for undergraduate medical education in Germany require a two-week practical training in general practice. Similar to other forms of medical education, this practical training should be regularly evaluated by students. With regard to special conditions of the training, we preferred a web based evaluation. Since adequate models were not available, we designed, implemented and tested an electronic way of evaluation. The following aspects turned out to be of special importance: teamwork, time, data protection and cost. Meanwhile, the evaluation is established and still accessible as demo-version for visitors of the home page. This electronic evaluation of medical training in general practice is highly appropriate for a timely evaluation allowing us to obtain a comparison between students' expectations and actual experience as well as a continuous supervision and to provide feedback to the participating practices. This is an important step for quality assurance of medical education in practices inside and outside the university.

Computer-Assisted Instruction↗

An evaluation of an educational intervention to improve death certification practice.

The objective of this study was to evaluate the effect of an educational intervention on the knowledge and behaviour of hospital staff pertaining to death certification. A questionnaire was administered, and certification error assessed both before and after written educational material was provided. Although the response rate to the questionnaire was disappointing (19.1%), the findings revealed a poor baseline understanding of the subject that improved after reading the educational material. Certification error fell from a baseline of 22.4 to 15.1% 2 months later, although the magnitude of the fall was not statistically significant. It was concluded that a simple questionnaire used in conjunction with educational material can focus attention on potential knowledge gaps relating to death certification. However, the educational effort needs to be sustained and linked to outcome assessment of certification performance in the institution.

Death Certificates↗

Evaluation of diabetes education programs: getting the answers you need.

In the time that has passed since our evaluation, 14 of the 16 recommendations we made have been addressed by the education staff and incorporated into the program. Program monitoring methods have been implemented and patient follow-up has been improved. After the recommendations were incorporated into the program, a final but noteworthy outcome of the evaluation process was achieved. Formal recognition as a model diabetes patient education program was given by the state of Ohio Diabetes Control Program. Systematic evaluation of a patient education program may seem an overwhelming and impossible task to accomplish, but with some creative brainstorming with staff it can be done. And the payoffs are worth the effort.

Data Collection↗

[Design and evaluation of an educational course for mothers of pregnant adolescents].

This article is the continuation of a previous investigation about educational necessities in perinatal health of pregnant adolescent mothers. Now we present the design and evaluation of an Educational Course for that group. The theoretical mark of the Course corresponds to the education of adults, under the focus of the grupal learning. The content included gineco obstetrics topics, prevention of perinatal risks and the analysis of the social and cultural enviroment. As evaluation instrument, a self-applicable questionnaire of thirteen open questions was built on four aspects: family dynamics, utility of the course, utility of the information and behavior of the pregnant adolescents. A sample of 101 mothers of pregnant adolescents participated of the study from January 1999 to May 2000. The results indicate that the family dynamics was modified favorably in 88% of the cases soon after the attendance of mothers like adolescents to their respective courses, although some factors related with the father show a lack of commitment about the family situation. The 100% of the mothers considered important the attendance to the course because it is an educational instrument, so much for pregnant daughters as for themselves. The Course propitiated the exchange of preventive information between them in 87% of the cases. 97% of the mothers informed changes in their daughter's attitudes soon after her attendance to the course.

Adolescent↗

Patient Education Corner. Accessing and evaluating the Internet for patient and family education.

In the last decade, the Internet has become a vast resource for healthcare information. Multiple Web sites, produced by the federal government, healthcare institutions, and individual healthcare providers, give Americans a wealth of useful information sources. Nurses recognize that more Americans than ever before are using the Internet and that nurses are in an excellent position to help patients learn how to search for healthcare topics and evaluate the information found. This article will focus on seeking information, judging the quality of the information, and listing specific Web sites.

Advertising↗

Application of a responsive evaluation approach in medical education.

INTRODUCTION: This paper reports on the usefulness of a responsive evaluation model in evaluating the clinical skills assessment and training (CSAT) programme at the Faculty of Medicine, Memorial University of Newfoundland, Canada. The purpose of this paper is to introduce the responsive evaluation approach, ascertain its utility, feasibility, propriety and accuracy in a medical education context, and discuss its applicability as a model for medical education programme evaluation. METHODS: Robert Stake's original 12-step responsive evaluation model was modified and reduced to five steps, including: (1) stakeholder audience identification, consultation and issues exploration; (2) stakeholder concerns and issues analysis; (3) identification of evaluative standards and criteria; (4) design and implementation of evaluation methodology; and (5) data analysis and reporting. This modified responsive evaluation process was applied to the CSAT programme and a meta-evaluation was conducted to evaluate the effectiveness of the approach. RESULTS: The responsive evaluation approach was useful in identifying the concerns and issues of programme stakeholders, solidifying the standards and criteria for measuring the success of the CSAT programme, and gathering rich and descriptive evaluative information about educational processes. The evaluation was perceived to be human resource dependent in nature, yet was deemed to have been practical, efficient and effective in uncovering meaningful and useful information for stakeholder decision-making. CONCLUSIONS: Responsive evaluation is derived from the naturalistic paradigm and concentrates on examining the educational process rather than predefined outcomes of the process. Responsive evaluation results are perceived as having more relevance to stakeholder concerns and issues, and therefore more likely to be acted upon. Conducting an evaluation that is responsive to the needs of these groups will ensure that evaluative information is meaningful and more likely to be used for programme enhancement and improvement.

Clinical Competence↗