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At least 1,063 records · Page 59Linked to original sources
PubMed2006

Exploring community nurses' perceptions of life review in palliative care.

AIMS AND OBJECTIVES: This exploratory study aimed to identify community nurses' understanding of life review as a therapeutic intervention for younger people requiring palliative care. The objectives set out to: (i) Describe the participants' understanding of reminiscence and life review (ii) Detail their current ideas regarding a structured approach to using life review in the community setting. (iii) Outline their understanding of the possible advantages and limitations of life review in relation to palliative care. (iv) Identify future training requirements. BACKGROUND: The literature review illustrated how the eighth developmental stage of Erikson's theory, ego-integrity vs. despair, is a 'crisis' often faced by older people entering the final stage of life. Life review is considered a useful therapeutic intervention in the resolution of this crisis. Younger terminally ill people in the palliative stage of an illness may face the same final crises due to their reduced lifespan. Therefore, this study explored the benefits and limitations of life review as an intervention in palliative care. METHOD: The study used a purposive sample of community nurses responsible for delivering generic and specialist palliative care. A qualitative method of data collection in the form of three focus group interviews was used. Subsequent data were manually analysed, categorized and coded with associations between the themes identified. RESULTS: The findings suggested that community nurses have limited knowledge pertaining to the use of life review and tend to confuse the intervention with reminiscence. Furthermore, they believed that life review could potentially cause harm to practitioners engaged in listening to another person's life story. However, the participants concur that with appropriate training they would find life review a useful intervention to use in palliative care. CONCLUSIONS: The results led to the identification of a number of key recommendations: Community nurses require specific education in the technicalities of life review and additional interpersonal skills training. The need for formalized support through clinical supervision is also recognized and discussed. Finally, suggestions are offered regarding the need to generate wider evidence and how, possibly, to integrate life review into existing palliative care services. RELEVANCE TO CLINICAL PRACTICE: This study has demonstrated that community nurses are keen to extend the support offered to younger terminally ill people who are in the palliative stage of their illness. Despite having limited knowledge of life the main components and underpinning theory pertaining to life review participants could appreciate the potential of life review as a therapeutic intervention in palliative care and were keen to learn more about its use and gain the necessary knowledge and skills.

Adult↗
PubMed1981

Sexual health care clinician in an acute spinal cord injury unit.

This article introduces the role of the sexual health care clinician, a nonphysician specialist trained to diagnose and treat sexual dysfunctions of disabled persons. Under medical supervision, the clinician is part of the treatment team in an acute spinal cord injury unit, a general rehabilitation center and an extended care unit. The clinician's role includes direct patient care; education for professionals, students and community agencies; liaison with other rehabilitation groups; and research. The process of sexual rehabilitation is conceptualized and experience with the specialty in an acute setting is described. Experience indicates that sexual assessment, diagnosis and management is a technical specialty which requires in-depth training. The major contributions of the service are an early legitimization of sex-related concerns; the crystallization of physiologic emotional and social capabilities and needs; and the specific instructions for experimentation with various sexual alternatives.

Adult↗
PubMed1984

Sealants: training and educational needs for dental students and dental auxiliary students.

A program of instruction in pit and fissure sealants has been described that includes didactic, preclinical, and clinical components (Table 4). The entire program requires the equivalent of three curriculum days. However, reinforcement of the principles of the technic should continue during the students' entire clinical training period. There are 203 accredited dental hygiene programs and 285 accredited dental assistant programs in the United States. Enrollment in these programs during the 1982-83 academic year was 10,051 hygiene students and 7,977 assisting students. Since 29 states currently allow dental hygienists to apply sealants and 11 states allow dental assistants, there is a compelling reason for sealants to be included in the curriculum of dental auxiliary programs. Unfortunately, other than Dr. Terkla's brief survey, there is no reliable information on the number of auxiliary programs that teach sealants, nor are there curriculum guidelines on sealant instruction for these programs. Nevertheless, the same training outlined in this article for dental students applies equally for dental hygiene and assisting students. A controversial question is whether clinical training in sealant application should be part of the curriculum of dental auxiliary programs in states that only allow dentists to apply them. This is not a question that can be resolved in this article, but must be considered at the individual schools involved. In these situations, a careful balance must be achieved between the academic freedom to teach current practices in dentistry and the dental practice acts of the state. The first commercially available pit and fissure sealant was marketed in 1970.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗
PubMed2005

Becoming an advanced practitioner in neonatal nursing: a psycho-social study of the relationship between educational preparation and role development.

AIMS AND OBJECTIVES: The aims of this research were to identify (a) the educational and working experiences and (b) subsequent training needs of graduates of one ANNP course in the UK. The objectives were (a) to assess the medium to long-term impact of the training programme on the professional development of the respondents; (b) identify potential areas of excellence and (c) areas for improvement in this and other training programmes for ANNPs. BACKGROUND: Neonatal intensive care continues to be a rapidly changing area of work. Nurses and doctors in neonatal intensive care units (NICUs) have to be skilled equally in interpersonal communications and technical expertise. The Advanced Neonatal Nurse Practitioner (ANNP) training programme was introduced in 1992 in the UK in the broader political context of extending nursing roles in a range of specialties. The role of the neonatal intensive care nurse had expanded elsewhere previously, particularly in North America as a response to medical staffing crises where the practice and the training/education programmes were expanded during the 1970s/1980s and continued to evolve to encompass an advanced role for the neonatal nurse practitioner. DESIGN: This was a study of five cohorts of graduates from one university course training programme for advanced neonatal practitioners (ANNPs) to explore their experiences of their role as ANNPs in the context of changes and developments in the British National Health Service and their own personal and professional development. METHODS: This study employs mixed methods (interviews, focus groups and a survey) and forms of data analysis (qualitative and quantitative) to explore the experiences of the transition to becoming an advanced practitioner. Data were collected from a sample of five cohorts; members of the current course team and the nursing and medical staff at one NICU which employs many of these graduates. RESULTS: Most graduates value their course experience and the ANNP role and the findings suggest that confidence about practice develops naturally with postcourse experience. However, the more experienced and confident ANNPs frequently reported increased inter-professional role confusion/conflict with junior doctors, and some consultants particularly where there are only one or two ANNPs overall in the team. CONCLUSIONS: There are personal and professional benefits to individual nurses who have had this training. However more attention needs to be paid to ongoing professional development particularly the management of professional role relationships among all nurses and between nurses and doctors. RELEVANCE TO CLINICAL PRACTICE: A focus on professional role relationships and more effective communication in the clinical setting would be of benefit to all members of multi-disciplinary teams. A greater level of day-to-day support is required for ANNPs, other neonatal nurses and junior doctors if this is to be achieved, especially in clinical settings where there are few ANNPs or the addition of these clinical specialists is relatively new.

Adaptation, Psychological↗
PubMed1984

The compleat otolaryngologist: Burton Alexander Randall.

The practicing otolaryngologist and resident is the beneficiary of a highly organized educational system which has evolved over the past 100 years. A number of social, scientific and technical advances were involved in the evolution of these training programs; however, one of the most important developments was the emergence of the Clinician Educator Concept. Burton Alexander Randall was prominent in the profession in the late nineteenth century and early twentieth century and is an example of the clinician-teacher who participated in the development of otorhinolaryngologic instruction. His unpublished memoirs, recently made available, illustrate the difficulties in obtaining appropriate training, organizing clinical services, and establishing professional relationships. These interesting documents provide insight into the present and illustrate that although there have been great technical advances, some problems in interpersonal relationships remain the same.

Education, Medical↗
PubMedDate not supplied

[Game biofeedback: networking].

Analyzed in the paper are stages of networking of game biofeedback. Three main stages are defined on the basis of practical experience, they are: unification of local databases, use of game biofeedback in local network and training in game biofeedback via Internet. Possible solutions are suggested; technical and organizational issues are discussed on working out and using a set of therapeutic and health-improving training equipment based on the principles of LAN game biofeedback.

Biofeedback, Psychology↗
PubMed1997

[Medicine in Turkey, with special reference to nephrology].

The stormy development of Turkey in this century resulted in a drastic decrease of illiteracy and in a craving for knowledge among the younger generations. Qualitatively good students are admitted to universities. In the last 25 years, 47 new universities were founded (8 of them private ones), partly for political reasons. Teachers of medicine are underpaid, so that many earn extra money by working in a private practice. The results of medical teaching are adequate, owing in part to quality and motivation of students and interns. Much research is being subsidized by the Turkish Institute for Scientific and Technical Research, Tübitak, but bureaucracy inhibits originality. Research and postgraduate training are increasingly controlled by the pharmaceutical industry. Primary medical care is underdeveloped. The quality of medical treatment is technically adequate; modern diagnostic and surgical methods are available in all major centres. There is much private enterprise in health care (private clinics, private laboratories, research centres, universities and pharmacies). The latest drugs are available and given preference in prescribing. In Southeast Turkey, populated by Kurds, however, the economy has come to a complete standstill and there is an enormous shortage of physicians and hospitals. The prevalence of renal diseases differs from that in the Netherlands: fewer cystic kidneys, less diabetic nephropathy and nephropathy due to analgetics, but more acute glomerulonephritis and amyloidosis due to familial Mediterranean fever. Haemodialysis, is one of the fastest-growing methods of treatment; peritoneal dialysis is rapidly gaining ground. Kidney transplantations have been performed regularly since 1975.

Delivery of Health Care↗
PubMed1992

Preservation of arm veins for arterial reconstruction.

The results of surgery for lower extremity salvage have improved steadily over the past decade. One of the principles accounting for this advance is the preferential use of autogenous veins for peripheral bypass surgery. Nonautogenous and prosthetic grafts to the infrageniculate (below knee) level have patency rates significantly lower than autogenous bypasses. Currently, the technical limits of bypass surgery often depend upon the availability of adequate venous conduits. The saphenous vein has been the conduit of choice for distal arterial bypasses. However, some patients lack saphenous veins as a result of previous vein harvesting for coronary or other arterial surgery, phlebitis, variations in venous anatomy, previous vein stripping, or other conditions. In these patients, arm veins (cephalic and basilic) have been used successfully for limb salvage. There are several requirements for the successful use of arm veins. These include a detailed knowledge of the anatomy of the cephalic and basilic veins, education of patients and health care professionals, nursing protocols to preserve arm veins, and the training of surgical nurses in the demanding technical maneuvers for arm vein implantation. This paper will address these subjects.

Aged↗
PubMed2004

The simulated operating theatre: comprehensive training for surgical teams.

Surgical excellence is traditionally defined in terms of technical performance, with little regard for the importance of interpersonal communication and leadership skills. Studies in the aviation industry have stressed the role of human factors in causing error and, in an attempt to reduce the occurrence of adverse events, led to the organisation of simulation based training scenarios. Similar strategies have recently been employed for the surgical team with the development of a simulated operating theatre project. This enables technical and non-technical performance of the surgeon and circulating staff to be assessed by experts situated in an adjacent control room, and provides an opportunity for constructive feedback. The scenarios have good face validity and junior surgeons can benefit from the process of learning new technical skills in a realistic environment. The effect of external influences such as distractions, new technology, or a crisis scenario can also be defined, with the ultimate aim of reducing the number of adverse events arising in the real operating room.

Clinical Competence↗
PubMedDate not supplied

Bridging refugee youth and children's services: a case study of cross-service training.

Bridging Refugee Youth and Children's Services(BRYCS), a public-private partnership between the federal Office of Refugee Resettlement, Lutheran Immigration and Refugee Service, and the United States Conference of Catholic Bishops, provides national technical assistance to public child welfare. After a series of "community conversations," BRYCS identified a lack of knowledge among child welfare staff about newcomer refugees, negative stereotypes, and a fear of child protective services among refugees. BRYCS initiated a number of technical assistance initiatives, including a pilot cross-service training project in St. Louis to strengthen collaboration between child welfare and refugee-serving agencies. This article details the lessons learned from this training and recommends changes in policy and practice.

Adolescent↗
PubMed2001

What do master surgeons think of surgical competence and revalidation?

BACKGROUND: There has been on-going debate and public interest in surgical competence in recent years. METHODS: A Delphi reiterative opinion survey was conducted among master surgeons on selection of surgical trainees, methods of assessment of progress of surgical trainees, and revalidation of established consultant surgeons. RESULTS: Selection-the current methods of trainee selection were considered inadequate and in need of revision. The important attributes recognized by group are cognitive factors, innate dexterity, and personality. Important aspects of personality include decision-making ability, insight, team spirit, and emotional stability. Assessment during training-the majority view was that this should be based on clinical judgement/skills, operative skills, and cognitive ability. Assessment of technical ability should be based on standardized checklists. Research within training programs was encouraged but academic achievement does not reflect surgical competence. There was a majority verdict for an exit clinical examination. Revalidation-the group agreed on the need for competence checks during the professional career of surgeons. These should cover knowledge, clinical, operative, and humanistic skills; but expressed concern on the feasibility of a revalidation system that can reliably assess the range of skills needed for surgical competence. There was a majority vote against an internal appraisal system. External assessment by nationally appointed 'assessors' was considered preferable. CONCLUSIONS: Both selection and assessment of surgical trainees require changes and standardization. Although revalidation is necessary, concern was expressed on the reliability and validity of existing and proposed systems.

Clinical Competence↗
PubMed2003

A computerized system to facilitate medical record abstraction in cancer research (United States).

OBJECTIVE: To implement a computerized system to gather and transmit medical record information from six sites to a centralized database for two cancer prevention studies. METHODS: Microsoft Access 97 was selected as the application for the system. Sites purchased Access and hardware meeting technical specifications required for the system. A developer worked with the lead investigator and medical record abstractors to develop a 'back-end' database to hold the desired data while maintaining a user-friendly 'front-end' interface. Abstractors trained on a paper version of the abstraction form were then trained to use the system. Meeting minutes and technical notes were used in summarizing the approach and process. Observations were collected through discussions. RESULTS: We overcame multiple obstacles to develop computerized systems supporting medical record data collection at multiple sites. Although system development slowed implementation of the study, the system produced data for cleaning and analysis immediately. Overall the approach decreased the time from study implementation to manuscript submission. Development time for a second system was substantially reduced. CONCLUSIONS: Computerized systems for medical record abstraction at multiple sites convey substantial benefit. We present a schematic approach to facilitate development of similar systems in the future.

Abstracting and Indexing↗
PubMed1999

[Technology of hyperbaric chambers].

Technical requirements for hyperbaric chambers are subject to permanent change. Medical gas supplies, the chamber hulls, control systems, medical equipment as well as the security check-up modalities have been constantly adapted according to the most recent technical developments. Moreover, different subtypes of hyperbaric chambers such as treatment facilities, chambers used for training purposes or facilities set up for primary experimental use require specific technical outfit. Keeping in mind some recent tragic accidents in hyperbaric facilities, chamber security is of foremost importance. Alarm- as well as technical monitoring systems, fire-fighting equipment, deluge systems and pressure locks are absolute requirements for any hyperbaric chamber. In chambers used for therapeutic purposes the possibility of invasive and noninvasive patient monitoring as well as hygienic standards have to be ensured.

Atmosphere Exposure Chambers↗
PubMed1977

Adolescent pregnancy: an interpersonal skill training approach to prevention.

The research literature reports numerous negative consequences of adolescent pregnancy. Unfortunately, contemporary approaches to preventing teenage pregnancies have been largely unsuccessful. Recent evidence, however, suggests that interpersonal communication skill training may represent an important step in helping adolescents deal with their sexual and contraceptive behavior. This describes a pilot study of an interpersonal skill training model for sexually active inner-city teenagers. Results show that this training model is a feasible and attractive approach to modifying the youths' communication patterns. Findings indicate that such training is a fruitful direction for future pregnancy prevention research with the adolescent target population.

Adolescent↗
PubMedDate not supplied

Technical competency in flexible sigmoidoscopy.

BACKGROUND: Family practice residencies offer training in flexible sigmoidoscopy; however, there are no objective recommendations for determining competency in learners. We describe a longitudinal study designed to determine the mean procedure time and depth of insertion for family practice residents. METHODS: During a 21-month period, data were collected for 421 patients undergoing flexible sigmoidoscopy. Second- or third-year family medicine residents supervised by family medicine faculty did all procedures. The data were analyzed with simple descriptive statistics, t test, and linear and logistic regression. RESULTS: The mean procedure time was 18+/-9.3 minutes (17.2 - 19.6, 95% confidence interval [CI]). The mean insertion depth was 51.4+/-12.4 cm (50.4 - 52.6 cm, 95% CI). Performing a biopsy was associated with an increase in procedure time (17.0 vs 27.3 minutes, P < .0001). Women with a history of pelvic surgery had less depth of insertion than did those who had no history of pelvic surgery (47 vs 53 cm, P = .002, t test). CONCLUSION: Procedural competency consists of knowledge, technical skills, and attitudes. Knowledge and attitudes can be assessed with other items, such as examinations and observation. Primary care faculty can now use these standards of insertion depth and procedure time when determining technical skill proficiency for their residents in flexible sigmoidoscopy.

Attitude of Health Personnel↗
PubMed1996

Altitude training for improvements in sea level performance. Is the scientific evidence of benefit?

Altitude training invokes physiological changes that are very similar to those caused by endurance training, As a result, it has been incorporated in the training regimes of elite athletes in an effort to improve sea level performance. Several training strategies, such as constant altitude exposure, intermittent altitude exposure or 'live high train low', have been used in an effort to incur an advantage in sea level performance over just sea level training alone. In spite of the accumulating scientific evidence that altitude training affords no advantage over sea level training, many coaches and athletes believe that it can enhance sea level performance for any athlete, whether endurance or power is the focus in their particular sport. However, altitude training may not be suitable for some athletes depending on their age, fitness level, health, iron status and the energy and technical requirements of their sport. The issue of whether altitude training enhances sea level performance remains a controversial topic.

Acclimatization↗